A version of this article appears in:
Transformative Motherhood: On Giving and Getting in a Consumer Culture. Linda Layne, ed. New York: New York University Press. 2000.
The Gift of Life: Surrogate
Motherhood, Gamete Donation and Constructions of Altruism
Blessed are those who can give without remembering,
and take without forgetting.
--Princess Elizabeth Asquith Bibesco
In
the anthropological literature, one of the first systematic and
comparative
studies on the cultural significance of gift giving was Mauss’s
The Gift. As Mauss so eloquently
said:
Things have values which are emotional
as
well as material; indeed in some cases
the
values are entirely emotional (Mauss 1967:63).
Mauss’s assessment of gifts is not dissimilar to
that of Levi Strauss who has also written:
Goods are not only economic commodities
but
vehicles and instruments for realities of
another
order: influence, power, sympathy,
status,
emotion ... (Levi Strauss 1965:262).
In
American culture, a culture in which commercialization penetrates nearly all
domains, one cannot help but be struck by the widely varied uses to which the
“gift of life” theme has been applied. The cultural significance of the gift
theme resides in its ability to provide both a literal and a symbolic
counterpoint to the increasing commodification of modern life. While many
anthropologists have studied the significance of the gift, it is interesting
that the gift for the most part remains
understudied in industrial capitalist society (Carrier 1990). Traditionally, in
American culture, the gift’s application has been confined (almost entirely) to
the arenas of blood donation and organ donation where it has been “lavishly
applied” (Fox and Swazey 1992:44). The inclusion of organ donation and blood
donation under the rubric of “gift” may be an attempt by participants and by
society to retard, at least symbolically, the trend toward the commodification
of life.{1}
My
own interest in the cultural resonance of the gift of life theme came about
somewhat circuitously as I was conducting research on surrogate motherhood.
During the course of that research, I discovered that surrogate mothers often
conceptualize the child/children they are producing for commissioning couples
as a “gift of life” and/or as “gifts.” This they do in spite of the fact that
they are compensated for their reproductive act.
With
traditional surrogacy (in which the surrogate contributes an ovum), both
surrogates and commissioning couples routinely refer to the children born of
these arrangements as gifts. This practice can be understood as related to
EuroAmerican kinship ideology, in particular its emphasis upon the importance
of biogenetic relatedness. Perhaps not surprisingly, I have also discovered
that with gestational surrogacy, where the surrogate gestates the couples’
embryos, noticeably less “gifting language” is utilized to describe these
children, an issue that I will address in greater depth in a later section of
this chapter.
The
gift of life theme, when applied to traditional surrogate motherhood, reveals
the ways in which issues such as work, indebtedness, pricelessness, family, and
kinship are being reconfigured. In this chapter, I would like to explore the
multivariant meanings attaching to the gift theme in the context of traditional
surrogacy, gestational surrogacy and gamete donation. I would also like to
explore how the gift of life theme serves as powerful reinforcement for
EuroAmerican kinship ideology and speaks (at least in the context of traditional
surrogacy) to the inviolability of the blood tie.
Methods
Data
for this chapter is the result of nine years of ongoing ethnographic research.
Twenty-six formal interviews of gestational surrogates were conducted, as well
as twelve interviews with individual members of couples (i.e., individuals who
had enlisted the services of gestational surrogates), in addition to five ovum
donors. Although several of the individuals I interviewed are/were clients at
the largest surrogate mother and ovum donation program in the world, several
were not. I also intentionally sought to interview couples who had advertised
for and screened their own gestational surrogates rather than contracting with
a program in order to compare their experiences against those of couples
enrolled in programs. In addition to these formal interviews I was able to
observe numerous consultations between program staff, intending couples and
prospective surrogate mothers, as well as, conducting thousands of hours of
participant observation. I have attempted, whenever possible, to select
individuals from the various phases of the gestational surrogacy and ovum
donation process, e.g., individuals who have not yet been matched, who are
newly matched and who are attempting “to get pregnant,” who have confirmed
pregnancies, who have recently given birth, as well as individuals for whom
several years have elapsed since the birth of their child. My decision to
interview individuals in all stages of the process has been to assess what, if
any shifts individuals might experience as they go through the process.
Background
When
I began my research on surrogate motherhood in 1988, gestational (IVF)
surrogacy was a relatively uncommon procedure. Surrogate motherhood
arrangements required that the surrogate contribute an ovum to the creation of
the child and be inseminated with the intending father’s semen. However, during
the six-year period that followed, the practice of gestational surrogacy
increased in the United States at a rather remarkable rate, from less than 5
percent of all surrogate arrangements to approximately 50 percent as of 1994
(Ragoné 1994;1998). With gestational surrogacy, the surrogate does not
contribute an ovum, but insteads “gestates” a couple’s embryo(s); and for this
reason, gestational surrogates in general tend to begin the process with
different concerns and expectations than traditional surrogates. But not all
gestational surrogate arrangements involve the couples’ embryos; numerous cases
involve the use of donor ova and the intending father’s semen. The question is
why do couples (who use donor ova) pursue gestational surrogacy when
traditional surrogacy can provide them with the same degree of biogenetic
linkage/relatedness to the child and has a higher likelihood of being successful.
It also costs significantly less. Typically, several reasons are cited by the
largest surrogate mother program which is now also the largest ovum donation
program in the U.S. with over 300 screened donors on file. The primary reason
is consumer choice, specifically that couples who choose the donor
ova/gestational surrogacy route rather then traditional surrogacy have a
significantly greater number of ovum donors to choose from than they have
traditional surrogates. But, of equal importance is that when commissioning
couples choose donor ova/gestational surrogacy they are severing the
surrogates’ genetic link to and/or claim to the child, whereas with traditional
surrogacy the adoptive mother must emphasize the importance of nurturance and
social parenthood, while the surrogate deemphasizes her biogenetic tie to the
child.
Remunerating the Gift
Thus
far, the image of surrogate mothers has been shaped principally by media,
legal, and scholarly portrayals of surrogates either as motivated principally by
monetary gain or as unwitting, altruistic victims of the patriarchy. This
tendency to cast surrogates’ motivations into either/or, often antagonistic
categories may reveal a great deal more about EuroAmerican culture than it does
about surrogacy itself.
Surrogates
readily acknowledge that remuneration was one of their initial considerations,
although they consistently deny that it was their primary motivation (and
nearly all surrogates state--repeatedly--that the importance of remuneration
decreased over time).{2} When questioned about remuneration, surrogates
consistently protest that no one would become a surrogate for the money alone
because, they reason, it simply “isn’t enough.” Many surrogate program
directors report that surrogates telephone their programs unaware that payment
is involved, a phenomenon that would seem to reinforce surrogates’ claims that
remuneration is not their primary motivation. As Jan Sutton, founder and
spokeswoman for a group of surrogates in favor of surrogacy, stated in her
testimony before an information-gathering committee to the California state
legislature, “My organization and its members would all still be surrogates if
no payment were involved,” a sentiment not unrepresentative of those expressed
by the many surrogates I have interviewed over the years.{3} Interestingly
enough, after Sutton had informed the committee of that fact, several members
of the panel who had previously voiced their opposition to surrogacy in its
commerical form began to express praise for Sutton, indicating that her
testimony had altered their opinion of surrogacy. In direct response to her
testimony, the committee began instead to discuss a proposal to ban commerical
surrogacy but to allow for the practice of noncommercial surrogacy (in which a
surrogate is barred from receiving financial compensation, although the
physicians and lawyers involved are allowed their usual compensation for
services rendered, as in organ donation). This perceptual shift on the part of
committee members can be understood to result from an overriding cultural
imperative that motherhood, reproduction and family be squarely situated in a
noncommercial sphere, a position which also explains why these same committee
members saw no inconsistency in permitting “professionals,” i.e., physicians
and attorneys, to receive compensation for services rendered.
The
following are typical surrogate responses to questions about how payment
influenced their decision to become a surrogate:
It
sounded so interesting and fun. The
money
wasn’t enough to be pregnant
for
nine months,
and:
I’m
not doing it for the money. Take
the
money. That wouldn’t stop me.
It
wouldn’t stop the majority.
and again:
What’s $10,000 bucks? You can’t even
buy a
car . . . . Money wasn’t important.
I possibly would have done it just for
expenses,
especially for the people I did
it
for. My father would have given me
the
money not to do it.
Surrogates’ devaluation of payment as insufficient
to compensate for “nine months of pregnancy” can be understood to fulfill two
functions. It is, of course, representative of the cultural belief that
children are “priceless” (Zelizer 1985), and in this sense, surrogates are
merely reiterating a widely-held belief when they devalue the remuneration they
receive. But their devaluation also serves as evidence that the perfect gift is
one that is priceless, one that transcends “material expression and economic
worth” and that renders the material immaterial (Carrier 1990: 23).{4}
Interestingly
enough, when the largest surrogate mother program changed its newspaper
advertisements from “Help an Infertile Couple” to “Give the Gift of Life,” the
new formula attracted the type of woman the program wished to attract and the
program received a considerably larger volume of response from suitable
prospective surrogates.{5} The ad struck a chord with surrogates because it
acknowledged that their act is one that can not be compensated for monetarily;
instead, it cast surrogacy in a poignant and life-affirming light, more clearly
locating it in the gift economy. The above example reveals the highly gendered
nature of the gift; falling as it does unequivocally within the female domain
be it surrogates, and ovum donors, but interestingly enough not with sperm
donors.
Surrogates’ dismissal of the importance of
remuneration also serves an underlying function, as reflected in the following
quotes. Here, a surrogate who had earlier dismissed the importance of money,
offers a more revealing account of her decision to become a surrogate mother:
I
wanted to do the ultimate thing for somebody,
to
give them the ultimate gift. Nobody can beat
that,
nobody can do anything nicer for them.
Another surrogate, who also used the word
“ultimate,” discussed her feelings about surrogacy in a similar way:
It’s
a gift of love. I have always been
a
really giving person, and it’s the
ultimate
way to give. I’ve always had
babies
so easily. It’s the ultimate gift of love.
Another surrogate echoed the gift theme:
They
[the couple] consider it [the baby]
a
gift and I consider it a gift.
And here, a surrogate who initially opposed AI
surrogacy explained her decision in this way:
I wasn’t using those eggs every month and
I
realized they didn’t mean as much to me
as I
thought they did. It was like giving an
extra
gift to the couple, one extra part
of
me.
We can surmise that when this surrogate used the
word “extra” to describe the gift, she did so as a means to underscore the
extraordinary nature of the gift. Another surrogate critiqued the very notion
of associating the child with a dollar value when she said: “You can’t put a
price on a baby’s life.”
The
gift formulation holds particular appeal for surrogates because it reinforces
the idea that having a child for someone is an act that cannot be compensated;
the gift of life narrative is further enhanced by some surrogates to embrace
the near-sacrifice of their own lives in child birth.{6} Thus, when surrogates
define the children they are reproducing for couples as “gifts,” they are
tacitly suggesting that no amount of money would ever provide sufficient
compensation. Distributive justice (Schwartz 1967) cannot be attained in the
traditional surrogacy arrangement. The child as a gift clearly approaches the
highest ideals of gift giving since it fulfils the criteria for the perfect
gift.
For
EuroAmericans it is “gift relations”
rather than economic exchanges that characterize the family (Carrier 1990:2).
Thus, when surrogates minimize or dismiss the importance of money, they are on
the one hand reiterating cultural beliefs about the pricelessness of children,
and they are on the other hand suggesting that the exchange of a child for
money is not a relationship of reciprocity but of kinship.
With
traditional surrogacy, the relationship is, as with adoption (Modell 1999: this
volume) one of indebtedness. Even though surrogates are discouraged from
thinking of their relationship to the couple as a permanent one, surrogates
recognize that they are creating a state of enduring solidarity between themselves
and their couples. This belief complicates the severing of that relationship
once the child has been born even though the surrogate knows in advance that
the surrogate-couple relationship is structured to be impermanent.
Surrogates’
framing of the equation as one in which a gift is given thus serves as a
reminder to their couples that one of the symbolic functions of money, namely,
the “removal of the personal element from human relationships through its
indifferent and objective nature” (Simmel 1978:297), may be insufficient to
erase certain relationships, and that the relational element may continue to
surface despite the monetary exchange.
Of
all the surrogates’ motivations, remuneration is the most problematic. On a
symbolic level, of course, remuneration detracts from the idealized cultural
image of women/mothers as selfless, nurturant and altruistic, an image that
surrogates do not wish to lose; in addition, if surrogates were to acknowledge
the money as a fair and equal exchange or sufficient compensation for their
reproductive work, they would lose the sense that theirs is a gift that cannot
be compensated for monetarily.
In
Britain, where commercial surrogacy was outlawed in 1985 with the passage of
the Surrogacy Arrangements Bill (Wolfram 1987:189), the situation has been
framed in moral terms:
The symbol of the ‘pure’ surrogate who creates
a
child for love was pitted against the symbol
of
the ‘wicked’ surrogate who prostitutes her
maternity
(Cannell 1990:683).
The idea of ‘pure’ versus ‘wicked’ surrogacy and,
correspondingly, good versus bad surrogates, is predicated on the belief that
altruism precludes remuneration. The overwhelming acceptance of the idea of
unpaid or noncommercial surrogacy (both in the United States and abroad) can be
attributed to the fact that it “duplicates maternity in culturally the most
self-less manner” (Strathern 1991:31). But perhaps even more important, the
rejection of paid or commercial surrogacy may also result from a cultural
resistance to conflating the symbolic value of the family with the world of
work to which it has long been held in opposition. Drawing together those two
spheres is the agency of the surrogate who bridges them through her
reproductive work. In the Baby M case, for example, the most “decisive issue”
was one of “payment to the surrogate” (Hull 1990b:155). As David Schneider so
succinctly described the equation, “what is done is done for love, not for
money. And it is love, of course, that money can’t buy” (Schneider 1968:45).
This truth is reflected in one father’s remarks
about his surrogate:
I realize now that what Jane [the surrogate] gave
was a
part of herself; that’s fairly profound.
Thus, the child serves as a point of connection
between the surrogate and the father in the same way that it does between the
wife and husband. When Swartz pointed out in 1967 that “the gift imposes an
identity upon the giver as well as the receiver” (Swartz 1967:2) he could not
have envisioned the literalization of this idea through surrogacy. By
acknowledging that the surrogate child is a gift, the couple accepts a
permanent state of indebtedness to their surrogate. The quote cited above, in
which the father refers to the surrogate giving part of herself, also reflects
the enduring quality of the blood tie, a relationship that can never be severed
in American kinship ideology. This is because, as Schneider noted, blood is
“culturally defined as being an objective fact of nature” (Schneider 1968:24).
It is therefore impossible for a person to have an ex-blood relative, e.g., an
ex-mother, ex-father, or ex-sibling (Schneider 1968:24). In addition to the
fact that blood is understood to be “a shared bodily substance,” there is also
the “connection between ideas of blood ... and ideas of genes” (Strathern and
Franklin 1993:20). Fathers cannot help but acknowledge this connection and
comment upon it, and neither can surrogates and adoptive mothers.{5}
Because
all gift giving creates a degree of gratitude, when couples bestow additional
gifts{6} upon their surrogates (as they do from the moment the pregnancy is
confirmed, to the moment the child is born and even after), they, like their
surrogate, enter into a gift economy. Gifts are given with such regularity and
predictability by couples to their surrogates (and to her children as well)
that such acts have become encouraged by surrogate programs. However, the
actual birth of the child and the surrogate’s relinquishment of the child to
the couple is viewed by all participants as the embodiment of the penultimate
act of giving/gifting. It is therefore of interest that couples routinely
bestow upon their surrogates gifts of jewelry that prominently feature the
child’s birthstone, a gift that (unlike impermanent gifts, e.g., vacations and
dinners) commemoratively embodies the birth of the child. As Layne (1999) in
her study of pregnancy loss narratives, reveals “memorial jewelry” specifically
“mother’s rings” which contain the child’s birth stone are often bestowed upon
the mother of a child lost through miscarriage or stillbirths as an undying
symbol of the child. While Layne’s work explores the utilization of goods/gifts
in the context of pregnancy loss, memorializing a child after her/his death can
also be extended to the gifts of jewlery bestowed upon surrogates.
Specifically, jewlery which contains the child’s birth stone memorializes the
surrogate child for the surrogate and, it might be argued that a surrogate
child is for many surrogates constructed in such a way as to also be
symbolically deceased. Such a gift represents an acknowledgement that
expensive, impermanent gifts such as vacations are mere tokens of appreciation
that cannot repay the extraordinary generosity of the surrogate, and here the
earlier surrogate comment “you cannot put a price on a child” is apropos.
In
this way, gifts of precious and semi-precious stones are intended to transcend
the lives of givers and receivers. In the case of surrogacy they are a particularly suitable gift since such
stones attempt to acknowledge the permanent connection that prevails between
surrogate and child and surrogate and father both of which bespeak the
inviolability of the blood tie in EuroAmerican kinship ideology. Of critical
importance for surrogates is their ability to describe the child as a gift, a
description which serves as validation for their reproductive work. But perhaps
of even greater importance, the gift formulation acknowledges their unique
contribution toward the creation of a family, an act that cannot (and in the
view of many participants, should not) be reduced to mere commodification. This
perspective also prevails in the world of adoption where the language utilized
by participants emphasizes the “gift, giving, and generosity” (Modell p. 11
this volume) and ultimately softens the idea that adoption creates a “market
for babies” (Modell 1999:11).
But
surrogates and couples also recognize, at least tacitly, that true distributive
justice cannot be achieved since such justice is only possible in pure economic
exchanges. It does not occur in social exchanges that involve relationships
(Swartz 1967:8), and certainly not in those that involve the gift of life. As
Fox and Swazey pointed out in their research on organ donation, it is not
unusual for organ recipients to feel a “sense of obligation” due to the
extraordinary nature of the gift proffered. Like an organ, a child is a gift
exchange that is “inherently unreciprocal” since it does not have a “physical
or symbolic equivalent” (Fox and Swazey 1992:40).
Commodifying Gestational Surrogacy and Gamete Donation
The
children produced through traditional surrogacy arrangements tend to be viewed
by all parties through the gift lens, a formulation that explicitly rests upon
the shared acknowledgement that what the surrogate gives is literally a part of
herself.{7} However, a shift has occurred as gestational surrogacy supercedes
traditional [which involves either the implantation of the couple’s embryos or
donor ova and husband’s/partner’s semen into a gestational surrogate],
specifically, this gift rhetoric is notably underused. One probable explanation
is the influence of the hegemonic biogenetic model of kinship. The explicit
articulation of relatedness reveals the tendency on the part of commissioning
couples to view themselves as “ending up with exactly the same child that they
would have ended up if it were not for the wife/woman’s inability to carry a
pregnancy to term,” as one resident psychologist explained to me.
Her
assessment demonstrates that with gestational surrogacy there is a tendency,
perhaps a logical one, for couples to place less emphasis upon the role and/or
contribution of their surrogate and more emphasis on the outcome. Because she
does not contribute an ovum, or a “piece of herself,” the surrogate’s role is
increasingly seen by some participants as that of “vessel” or “vehicle,”{8} as
reflected in couples’ language. For example, one 36-year -old father offered
the following assessment concerning the role of his gestational surrogate and
her relationship to him, his wife, and the child:
I
don’t think about it much. She was an
oven . . . .
she
doesn’t see herself as the mother. We
don’t
see her as the mother and that’s the way
it is
[emphasis added].{9}
With
gestational surrogacy, commissioning couples place less emphasis on the
children as gifts and greater emphasis on the processural component of
reproduction than do AI couples. When I discussed my theory about the absence
of gift rhetoric with the director of the largest surrogate mother program, she
confirmed my observations. She had observed, for example, that IVF
(gestational) surrogacy couples, are in her experience, “more difficult” and
“less kind at the birth and soon after the birth” to their surrogates.
Typically, for example, surrogates want their own children to see and/or hold
the child/children shortly after they are born. This practice is intended to
provide the surrogate’s children (and the surrogates themselves) with closure,
and it is encouraged by the program and its psychologists. And here again, this
director observed that the only time “I have had couples run out of a hospital
[with the baby] is IVF couples. AI couples will stay around for 10 days [after
the birth of the child and her/his discharge from the hospital].” AI couples,
on the other hand, the director noted, “want the [surrogate’s] children to hold
the babies.” By way of explanation, many IVF couples say that they do not want
anyone holding their children because they fear contagion or “germs.” But the
director’s observation were that these couples appear to feel that a
surrogate’s children “have the right” to hold their infants and they “almost
behave like a stranger situation.”
Even
when the pregnancy produces a multiple birth, a fairly common phenomenon, a
situation that might be expected to produce a heightened sense of gratitude in
couples, the director had observed that they are actually less “kind” to their
surrogate than when a “singleton” (one child) is born. The center’s contract
states that for every additional child couples must pay an additional $3,000
and, according to the director’s assessment, a new pattern is emerging in which
couples who have twins or triplets tend to give their surrogates smaller gifts.
Couples frequently propose to give expensive gifts to their surrogate but very
few IVF couples who receive multiple children keep this promise, and it appears
(at least initially) that surrogates who give birth to singletons receive more
gifts. How do we account for this behavior? The program director’s theory is
that because a multiple birth means that a couple’s family is complete and will
no longer require the surrogate’s services (or the program’s services), such
couples therefore “don’t care what the we think of them either,” often flouting
program directives concerning appropriate behavior toward their surrogate.
Ovum Donation: Where Have all the Gifts Gone?
My
interest in gamete donation was generated by the intersection of ovum donation
with gestational surrogacy. The largest surrogate mother program is also the
world’s largest ovum donation program. Intending couples who are unable to
produce their own embryos have the option of choosing from over 300 screened
ovum donors at the surrogate program. It should be noted that what constitutes
relatedness in one context and appears to be consistent with EuroAmerican
kinship ideology is, however, inconsistent in other contexts, most notably with
gamete donation.
Interestingly,
gamete donation programs/clinics/banks intentionally seek to separate gametes
from their donors in ways that bear a striking similarity to adoption
practices. Like adoption, gamete donation (both ovum or sperm donation) “arose
out of market concerns; an imbalance between supply and demand, a scarcity of
the desired product ...” (Modell 1999:6 this volume.), and it was the
routinization and naturalization of IVF that resulted in an increased demand
for ova. Intense competition among infertility clinics and the prospect of
enormous profits coupled with weak regulatory policies (Reame 1998:1) has created
a volatile environment. Although a great deal has been written about the
practice of inflating their “success rates,” at infertility clinics little has
been written about the common practice of advertising for ova donors in college
newspapers. Acting on the questionable assumption that women in college possess
the genetic potential to produce more intelligent children, clinics seek ova
from a cohort known to be in need of financial compensation by using financial
incentives (just as sperm banks do). It is interesting to note that while
gamete donation programs/banks only accept donations from individuals who are
either currently enrolled in college (or who are college graduates) no such
emphasis exists in the field of blood or organ donation. In an attempt to
recruit college-aged women, advertisements for ova donors have changed their
rates from a $2,500 payment for one cycle to a single, larger sum of $10,000
(for 3-4 cycles), a sum of money that is more attractive. These ads do not
indicate, however, the number of cycles involved in the larger payment,
intending to draw in candidates through the appeal of a lump sum payment. Ovum
“donation” then, like sperm “donation,” is explicitly predicated on a
remunerative model, it may appear to be outside the province of gifting, but it
is not.
The
idea of altruism in the context of gamete donation, in particular ovum donation
provides a particularly interesting and vital link to an understanding of the
complexity of the gift. As we will see gift rhetoric is not only contextually
dependent, it is also highly gendered.
Gendering the Gift
Gender
in the world of assisted conception is a crucial, if curiously understudied
variable, particularly with respect to men and gamete donation. For example,
studies on sperm donation have revealed that: 71% of sperm donors are motivated
by the following factors: remuneration (Schover et al., 1992), a desire to
assess their own fertility (Handelsman et al., 1985; Daniels 1989), altruism
(Handelsman et al., 1985; Daniels 1989; Schover et al., 1992) and,
interestingly enough, outcomes, i.e., donors are interested in knowing whether
children were born from their donation (Handelsman et al., 1985; Daniels 1989;
Mahlstedt and Probasco 1991; Purdie et al., 1994; Schover et al., 1992). Before
a donor is accepted his semen is accessed for motility, sperm count, and so on
which allows a donor to assess his fertility. These test results are different
from those that inform donors about the actual number of births that have occurred as a result of
their act of donation.)
Given a cultural model that equates good
morther with nurturance and altruism, ovum donors are less likely than sperm
donors to acknowledge the importance of remuneration. The dictates of this
cultural model are mirrored by sperm banks and ovum donation program staff.
Clinicians, for example, are “highly influential” in “creating the overall
atmosphere . . . in which donors and
recipients experience gamete donation,” (Hamies 1993:1518) as revealed in a
study conducted by the University of Southern California’s oocyte donation
program. Clinicians Sauer and Paulson reveal that as part of the screening
process for prospective ovum donors the USC program insists that the “primary
reason for participation . . . [be] a
desire to help an infertile woman have a baby” (Sauer and Paulson 1992:727). In
spite of this policy, which is intended to screen out women who express
financial incentive, 76% of the women who had completed “at least one
aspiration stated that compensation was important for their continued
participation” (Sauer and Paulson 1992:727).
Why
then are women who express some financial motivation turned away in spite of
the fact that approved donors, once accepted, subsequently reveal that
remuneration is important to them? And why are sperm donors, who routinely
state the importance of financial compensation, accepted? Sauer and Paulson’s conclusion was that
“oocyte donors represent a rather unique group of individuals. . . . very
different from men donating to our sperm bank” (Sauer and Paulson 1992:726), a
conclusion that is questionable in view of the fact that 76% of that program’s
screened and accepted ovum donors appear to value compensation as do 71% of all
sperm donors. Such assessments regrettably conflate commonly accepted,
essentialist notions about gender, selectively reinforcing ideas of “altruism” and “gifting” only as they
pertain to women.
The
irony of programs using financial incentive to attract ovum donors and then
requiring them to deemphasise its importance reveals a deepseated ambivalence
in EuroAmerican culture about commercializing, commodifying, and fragmenting
both the body and the family. And ovum donors are the first to reflect this
ambivalence. As one 28-year-old ovum donor’s unsolicited explanation
illustrates, “Whatever money I acquired I would use in some way to better my
children’s life.” Another ovum donor
felt that her donation needed an explanation,, “I got brownie points
somewhere.” As these remarks reveal, it is not uncommon for ovum donors to
indirectly apologize for or somehow excuse their having accepted compensation
for their reproductive work. Responses such as these harken back to the
script-like quality responses I received from traditional surrogates to
deemphasize the remunerative component and to foreground ideas consistent with
feminine/maternal behavior, such as altruism, caring, and sharing (Ragoné 1994;
1996); such responses can be understood to reflect the tension between market
driven forces that set the price on how much an infertility clinic can
compensate a donor for her ova and the altruistic component of donors’ acts.
One 24-year-old donor provided a fairly explicit synopsis of this cultural
tension when she said:
I was worried what people would think
of
me. A close friend made a snide comment
about me selling off parts of myself. It made
me feel like it was a trashy kind of thing to
do.
What kind of women would do it? Then it
became,
‘I am
the kind of women who would do this!’
Specifically, when programs insist
upon anonymity, i.e., minimal or no contact between ovum donor and intending
couple, they tend to reinforce the idea that gamete donation is a quid pro quo
exchange, i.e., donors receive payment and couples receive gametes. But although
psychological studies indicate that the anonymous model is not ideal, most
programs respond the the wishes of their paying clients (Baran and Pannor
1989). As the director of the world largest sperm bank informed me, in spite of
his own psychological staff informing him of the importance of abolishing
anonymity and moving the bank into a more interactive and open model, there are
currently no plans to implement this since he reasoned it is not what his
clients. The belief that children’s psychological response is healthier when
they are informed of their birth origins, that secrecy in the family should be
discouraged, and that infertile individuals must come to terms with their
infertility are the primary reasons that psychologists recommend more interactive
open models be implemented for donation.
Anonymous
models of donation appear to have produced negative consequences for some
donors as revealed by a 28-year-old ovum donor whose first donation
[facilitated by a private physician] was completely anonymous. She described
her experience as an emotionally difficult one:
It
made me feel like a prostitute.
It
was disgusting. I left there crying.
In
the end, I said, ‘I will never do this
again.’
It was a horrible experience.
However, she went on to donate two additional times
in a program that encouraged open communication between ova donors and
recipient couples/individuals. One of the psychologists at the program she
chose described the donor’s decision to donate again in an open program as one
that “help[ed] her to heal.” In this case, participating in an open donation
program appears to have accorded the donor a greater degreee of agency and to
have placed her act of donation into the gift economy.
The
decision of many clinics to retain the anonymity model in spite of evidence
that it is not necessarily in the best interest of donors or children has produced an untenable situation for many
ovum donors since they are required, on the one hand, to view their donation as
altruistic, an aspect of the gift model, but on the other hand, because they
will never have contact with the couples or women who receive their ova the
relationship resembles an economic arrangement. The previously quoted donor who
reported feeling that she had “prostituted” herself, and the other who felt
that she was “selling body parts,” were expressing feelings remarkably similar
to those expressed to me by surrogates participating in anonymous programs,
namely that the process served to produce feelings of fragmentation of self.
Anonymity
facilitates the denial of the genetic component of donation for both donors and
recipients and permits recipient couples to deny their infertility. The
following quote by a 32-year-old, however, reveals the confusion faciliated by
an anonymous model that seeks to ignore issues of relatedness,
I
thought ‘wow, my eggs are going
to be
a child.’ I don’t consider it my
child.
It is in a way my child. It was a
weird
feeling. Donating eggs is much
different
than being face to face with
what
you donated. I don’t think of them
as
related to me.
Although this donor later added, “It’s a good
feeling helping someone have a baby,” it is not uncommon for ovum donors to
ignore the link between ova and children. This conceptual gap is the byproduct
of both anonymity and commodification.{10}
One
33-year-old ovum donor explained her view of the separation between her ova and
the potential child in this way, creating a self and other distinction based on
that which is inside the body and that which is outside the body,
It [the baby] really isn’t mine even though
they
[the ova] are mine. Once it’s not in
me,
I
don’t consider it mine. [Italics added]
Her
statement echoes the perception embraced by most gestational surrogates,
specifically, that the children are not theirs because they do not have any
“genetic” connection to the children they produce. The difference, however,
between gestational surrogates and ovum donors is that ovum donors are in fact
genetically linked to these children, whereas gestational surrogates are
not.{11} But what is of fundamental importance is that various versions as to
what does or does not constitute relatedness in EuroAmerican kinship ideology
co-exist and their co-existence has a great deal to do with the fragmentation
and commodification of the body, as illustrated by the following quote by
28-year-old donor mentioned earlier who analogized her donation experience to
that of prostites. Placing her gift in context, she added the following:
I compare it [ovum donation] to donating
blood,
platelets or bone marrow. You aren’t
giving
life, but you are saving life.
[Emphasis added]
Her statment can be understood as an attempt to
reconceptualize her act of donation and to provide a more finely textured,
albeit unclear, theory about life, i.e., “giving life” we are informed cannot
be understood as the equivalent of “saving life,” a distinction which reveals
the deepseated ambivalence some ovum donors experience. One psychologist who
routinely screens ovum donors informed me that ovum donors often equate their
donation with blood, organ and bone marrow transplantations, an analogy that is
intended to include their act of donation in the gift economy. One particularly
astute 24- year-old donor described her experience of trying to separate
herself from her ova and the potential child in the following way,
I was concerned I would have an emotional
attachment
to the baby. I was concerned down
the
road if I was the biological mother. If the child
wanted
to meet you . . . it would be cruel not to. It is
something
I don’t think about a lot. Keeping up that
line
in my mind I knew that the one thing I had to do
was
keep an emotional distance in myself . . . I knew I
had
[to] for my own sanity, I had to do it. I had to draw the
line
in the sand because I cannot risk an emotional
attachment.
The
attempt at emotional distancing and the figurative act of “drawing a line in
the sand” to separate herself from the child(ren) a donation might produce
represents both an explicit acknowledgement of the biogenetic tie and an
attempt to deny that connection. In another study that examines the experiences
of recipient couples at The Center for Reproductive Medicine and Inferility at
Cornell University Medical College, Applegarth, et al., inform us that 90% of
couples in their program use anonymous donation while another 9.7% use “known” donation, e.g., biological
sister donation (Applegarth, et al., 1995:576). The authors concluded that only
a “small percentage,” 10% of husbands and 26% of wives, “expressed the desire
to meet their ovum donor” (Applegarth, et al., 1995:577), but the fact that
more than one-quarter of the women wanted to meet their donors seems
significant, especially in a program where such meetings are in all likelihood
discouraged. It is also impossible to ascertain whether the following remarks
attributed to several recipient women are typical. According to Applegarth et
al., recipents offer thanks for their ovum donation in the following order: to
“God,” “the wonders of modern medical miracles,” and “fantastic technology.”
Only one of the recipients had expressed thanks to her donor (Applegarth, et
al., 1995:580).
The
attempt by programs and clinicians to argue that anonymity is an acceptable
strategy may be understood as an attempt to privilege the desires of paying
clients, i.e., the recipient couple, a practice that has a long history in the
annals of sperm donation. It is disconcerting that, due to the anonymity model,
individuals who are able to have children through gamete donation do not feel
the same sense of indebtedness to their donors as do those who participate in
traditional surrogacy. As we have seen, the practice of anonymity in both ovum
donation programs and sperm banks contributes to the further fragmentation of
reproduction and the body, a fragmentation that is inextricably connected to
the desire to maintain the commodification model.
Conclusion
An exploration of the gift in the
context of surrogate motherhood and gamete donation illuminates the many and
contradictory tensions that the commodification of life produces, from a
resistance to conflating the symbolic value of family with work, on the one
hand, to a desire to justify and even embrace the commodification of life on
the other. With surrogacy, as with gamete donation, the enduring power of
EuroAmerican kinship ideology continues to surface in spite of concerted
attempts to obscure it. As one surrogate program director stated, in the course
of discussing the New Jersey Supreme Court’s ruling that surrogacy represents a
form of baby selling in the Baby M Case, “How can a father buy his own
child? He can’t!”
Whether
it is used in surrogate motherhood or gamete donation, gift exchange is, as
Malinowski noted, “one of the main instruments of social organization”
(Malinowski 1922:167). It sheds light on the quality and value of human
relationships (Titmus 1971:13), and the multivariant forms that the gift of
life takes will undoubtedly continue to puzzle and in some respects confound
us, as technology continues to raise previously unimaginable questions.
End Notes
1. However, it is important to bear in mind that in
spite of the heavy symbolic load associated with the gift of life 35% of all
blood donors in the United States were paid for their donation until 1964
(Titmuss 1971: 93), and this practice which attracts “alcoholics and other
unfortunates who return frequently to blood banks” (Titmuss 1971:114).
Remuneration is a critically important issue since many blood donors are aware
that “they will be deprived of money if they answer yes to questions about
jaundice, malaria, and other infectious diseases” (Titums 1971: 114). It is
clear that the practice has affected the safety of our blood supply; and
experts have concluded that blood received from noncommerical banks is
categorically safer than blood obtained from commerical banks (Titmuss 1971:
152). Profit also permeates the field of organ donation and it has resulted in
the argument that a donor’s family is entitled to compensation (reference) (for
their loss, act of generosity, and because all the other parties involved
benefit, e.g., the recipient, transplantation teams, hospitals, and so on), a
position to which I have expressed strong opposition (Ragoné 1996).
2. The
version frequently put forth by surrogate mother programs is that the
importance of money decreases as the pregnancy progresses.
3. Since
1988 I have formally interviewed 30 traditional surrogates and 25 gestational
surrogates, and I have also had countless informal conversation with
surrogates.
4. This tendency to deemphasize remuneration has
also been found among Norwegian teenage baby-sitters (known as passepike,
or girls who “look after” children). Marianne Gullestad reports that even
though remuneration is important to these girls, they share in a cultural
ideology that devalues the importance of payment for such a service. For this
reason, when asked, the girls say that “they do not look after children for the
sake of money, but because they are fond of children (er glad I
barn)” (Gullestad 1992:119).
5. The
program had changed its advertising copy due to the fact that the newspaper
refused to print an ad that explicitly sought a woman to serve as a surrogate.
This policy has since changed.
6.
Surrogates frequently discuss their feelings concerning difficult pregnancies
and deliveries in terms that suggest “heroic suffering” and “heroism” (Ragone’
1994, 1996).
7. Interestingly enough, in other contexts, all
parties intentionally deemphasize this contribution (Ragoné 1994; 1996).
8. Tentatively, I would suggest that this appears to
be especially true when couples have located their gestational surrogate
independently rather than through a program since they do not receive any
guidance about appropriate behavior.
9. When this husband’s wife telephoned me one year
later (for information unrelated to our interview) she apologized for the way
her husband had spoken of their surrogate, assuring me that he no longer felt
that way although she did not provide specific details of, glossing over his
comments and seeming embarrassed by them.
10. Even in anonymous programs, it is not unusual
for donors to inquire about the outcomes of their donation. Some programs do
inform donors as to whether or not their donation resulted in children. Some
also provide information about the gender of the child, while others will not.
11. Fathers it should be noted who have participated
in traditonal surrogacy also tend to downplay the significance of their genetic
relationship to the child by foregoing the paternity test (Ragoné 1994; 1996).
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