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An International Agreement on Commercial Surrogacy?

Posted by Marcy Darnovsky on September 4th, 2014


A lively and informative three-day forum convened in The Hague from August 11-13. The International Forum on Intercountry Adoption and Global Surrogacy brought together nearly a hundred scholars, women’s health and human rights advocates, and policymakers from 27 countries at the International Institute of Social Studies of Erasmus University, the Forum’s host organization.

The Forum aimed to provide a venue “to discuss ways to improve international standards around the evolving practices of cross-border adoption and surrogacy, in which children typically move from poorer to wealthier countries.”  The Center for Genetics and Society chaired the “Global Surrogacy Practices” thematic area of the conference.

Serendipitously, the Forum occurred in the wake of headlines about two disturbing surrogacy incidents in Thailand. In one case, an Australian couple was accused of abandoning their baby son, who has Down syndrome, with his Thai surrogate mother and returning home with his twin sister (1, 2); the husband was then revealed to have been convicted of multiple child sex offenses that took place between the early 1980s and early 1990s against girls as young as five. In the other news story, a young Japanese businessman fathered sixteen children since June 2013 with Thai surrogate mothers, claiming that he wanted a large family (1, 2).

These incidents took surrogacy out of its usual celebrity-driven spotlight and highlighted the risks of unregulated international surrogacy arrangements for a broader public. For Forum participants, they also underlined concerns about children born as a result of contract pregnancies, and set the stage for discussions of the “best interests of the child,” which is a foundational concept of the 1993 Hague Convention on Intercountry Adoption (HCIA).

By design, the Forum took place in advance of the Hague Conference on Private International Law’s upcoming considerations of its work on intercountry adoption and surrogacy. Implementation of the HCIA, and ongoing concerns about patterns of fraud and “failed” adoption, will be discussed by its Special Commission in spring 2015. In roughly the same time frame, the Hague Conference staff (known as its “Permanent Bureau”) expects to receive guidance from its member countries about whether and how to move ahead toward a possible convention on international surrogacy. Members of the Hague Conference Permanent Bureau participated in the Forum, and indicated their active interest in the discussions and evidence presented there.

Forum participants who have focused on surrogacy and those who have worked on intercountry adoption learned a great deal from each other over the course of the three-day event. Adoption experts presented data regarding the past and present challenges of international adoption faced in countries such as Ethiopia and Guatemala, while surrogacy experts shared findings from India, Mexico, Israel, and elsewhere. Several anthropologists and advocates presented accounts of their fieldwork with surrogate mothers in India, a major destination for international surrogacy, and the country in which it has been most intensively studied.

Meeting jointly and in smaller groups, participants identified and discussed several similarities between intercountry adoption and surrogacy, surrogacy and explored how lessons learned from decades of work by the international adoption community might inform surrogacy practices. One issue that is now more or less settled in the adoption context is that adopted children are entitled to “legal openness” about their biological origins; this raises the question of whether children born in surrogacy arrangements should also be granted access to information about their genetic and gestational origins. Adoptees repeatedly stressed the preservation of records as a primary concern for surrogacy practice. Another question turns on the similarities between the situations of birth mothers of adoptees and surrogate mothers, and on how their health, interests and rights can be protected. A third concerns the role of intermediaries in the two practices, and whether, and under what conditions, agencies are part of the solution or part of the problem.

Differences between intercountry adoption and international surrogacy are also instructive, and were the focus of many discussions at the Forum. In the case of adoption, the assumed starting point is a child in need of a home; with surrogacy, it’s adults who wish to create a child in order to become parents. Also, most countries see intercountry adoption as a practice that at least in some circumstances should be supported; in contrast, most countries currently prohibit commercial surrogacy altogether and face the quandary of what to do when their citizens flout these laws and go abroad to the handful of jurisdictions that allow it.

Participants whose work has focused on issues of parentage and citizenship of children born in international surrogacy arrangements, and those focused on the conditions of women working as surrogates, were able to easily agree that any international convention – as well as other policy or advocacy efforts – should protect the rights and well-being of all parties: children, women working as surrogate mothers, and intended parents. There was also agreement that any international convention should be structured so that it does not pressure  jurisdictions that prohibit commercial surrogacy to loosen their laws.

In its Preliminary Report on the Issues Arising from International Surrogacy Arrangements (March 2012), the Hague Conference Permanent Bureau focused primarily on the “best interests of the child” in intercountry surrogacy arrangements, especially these children’s citizenship and parentage status. But the Report also covers concerns about psychological and health issues they may face, and includes strong language about the urgency of addressing the documented patterns of abuse and human rights violations against surrogate mothers.

While Forum participants shared strong concerns about the problems that intercountry surrogacy arrangements raise, and about minimum standards for any projected international convention, many were fundamentally unsettled about commercial surrogacy itself and about the best policy option for addressing it. Some consider commercial surrogacy unacceptable, on the grounds that it commodifies and commercializes both babies and women’s reproductive capacities. From this view, commercial surrogacy should be prohibited because it exploits women, especially those who have few other economic options, and constitutes a form of baby selling.

Others believe that harms to surrogate mothers can be addressed by defining contract pregnancy as a form of work, and establishing regulation and oversight to improve labor conditions. Their views are based either on a pragmatic sense that international surrogacy is already an established fact and that policies to protect those involved are urgently needed, or on the belief that surrogacy can benefit women who have few other options for earning the kind of money this work can bring them. Some participants reported that they changed their mind on these questions during the Forum, in one direction or another; most agreed that the animated and thoughtful exchanges had opened their minds to aspects of the issues they had not previously considered or taken seriously.

The Forum’s discussions and deliberations made clear that the issues raised by international commercial surrogacy are complex and that opinions about it are varied, even among women’s health advocates and feminist scholars. The wide range of concerns expressed, and the evidence on which they are based, will help inform the Hague Conference as it continues to consider the feasibility of a convention on international surrogacy.

Recordings of the Forum’s three plenary sessions will soon be posted on its public website, and a report on the discussions and deliberations will be published later this fall.

Previously on Biopolitical Times:







"3-Person IVF" Debated in UK Parliament

Posted by Pete Shanks on September 3rd, 2014


Fiona Bruce, MP, opens the debate

The British government continues to move toward legalizing a form of inheritable genetic modification that would combine eggs or embryos from two women in an effort to prevent the transmission of mitochondrial disease. But the controversy over the technique, variously known as "3-person IVF," "mitochondrial replacement," and "nuclear genome transfer," is far from over, and the issues received a public airing in the House of Commons on September 1st.

This was not the official government-initiated debate — that remains some way off — but one brought by a group of MPs who urged the government "to delay bringing forward regulations on mitochondrial replacement" until more research had been completed. (The British system combines the executive and legislative powers but also allows some time for debates requested by members of parliament who do not hold party or government office.) The complete transcript is available, as is archived video.

Opinion in the House of Commons was clearly divided. About half of those who spoke favored moving forward with the technology, some for rather crass reasons ("this is a great piece of British scientific advance"), some out of understandable concern for individual constituents who suffer from mitochondrial diseases. The debate also stirred some local newspapers to feature patients criticizing MPs for "standing in the way of a pioneering new treatment" or wanting to "help future generations."

Perhaps the most striking speech, however, was delivered by Conservative former minister Sir Edward Leigh, who stressed the ethical issues around inheritable genetic modification:

Bioethicists have up until this point expressed almost universal consensus on germ-line genetic modification of our fellow humans, rejecting it as grievously immoral and completely unethical. The consensus is worth pointing out as we must know what the proponents of mitochondrial transfer are asking us to dissent from. They are asking us to dissent from opinion in every other country in the world. In this age of globalisation, we will be divorcing ourselves from the entire community of nations in terms of bioethics. Do we really want to become a rogue state in terms of bioethics?

Leigh was featured in the report by the conservative Daily Telegraph, but this was not a party-political issue. Labour MP Jim Dobbin — a scientist by training — was concerned about the lack of evidence, and cited David King of Human Genetics Alert, who "fears that science is racing ahead of ethics [and] that we are in danger of creating designer eugenic babies." (Stuart Newman and Paul Knoepfler were quoted by the conservative MP Fiona Bruce, who introduced the motion.) Another Labour MP, Robert Flello, endorsed the ethical concerns and stressed the public safety issues:

To put it crudely, there is every possibility that we could be legislating to allow techniques that could cause damaged embryos, resulting in further damaged children. That is not spin; it is a reasonable assumption based on the available data. Newcastle University's own paper concluded that, compared with control experiments, 50% fewer eggs fertilised through pronuclear transfer reached the blastocyst stage-in other words, pronuclear transfer is twice as likely to cause the embryos to fail. … We might not know the result for many generations. We might not know whether some damage has been caused until three, four or five generations later. We simply cannot know that.

The Parliamentary Under-Secretary of State for Health, Jane Ellison, called it a "thought-provoking debate" and did acknowledge that some Members had concerns. She stressed that the draft regulations "would also bring into place important safeguards" but remained committed to moving forward. To what extent the concerns expressed will affect the final proposals remains unclear.

Previously on Biopolitical Times:





Disability Will Never Be Immoral

Posted by Jessica Cussins on August 29th, 2014


The summer's "ice bucket challenge" has brought an extraordinary amount of attention to amyotrophic lateral sclerosis (ALS), a neurodegenerative disease impacting nerve cells in the brain and spinal cord. What you may not know about ALS is that it is only very rarely inherited, at least through any determined genetic mechanism. It is currently thought that "only about 5% of all patients with ALS will have a genetic change" causing the disease. Genetic testing is available for patients who have both symptoms and a family history, but it is rarely recommended.

This does not mean that genetic testing for ALS will not be marketed to people concerned for their health, or for that of their children, especially given the peak in interest at this time. Genetic screening for the "breast cancer genes" BRCA1 and BRCA2 has become widespread, and prenatal genetic tests to detect them are also on the rise. But as with ALS, the vast majority of breast cancer cases have nothing to do with inherited genes.

Of course, there are plenty of traits that are more clearly and commonly linked to genetic variations. Prenatal genetic testing for such conditions significantly raises the stakes of what can be done with that knowledge.

All parents-to-be must be able to make their own choices about their ability to raise any child, but unfortunately too many are presented with a prenatal diagnosis without accompanying information about what it actually means for their child or their family. The slick marketing of prenatal genetic testing has sparked concern about its propensity to dehumanize conditions while normalizing specific responses. This is certainly true for the most frequent chromosomal disorder, Down syndrome, which has also been a prevalent media subject this summer thanks to a couple of strange and sad happenings.

The most sensational story has been that of Baby Gammy, the boy with Down syndrome who was left with his Thai surrogate mother when his Australian parents returned home with only his twin sister, who did not have that extra chromosome. People around the world were outraged as the (still contentious) details emerged: that the parents had asked the birth mother to have an illegal abortion, that they then left Gammy in Thailand when they believed he had mere days to live, that the father had previously been convicted for 22 child sex offenses. The more recent coverage of a California couple who had a similar experience further highlights the prevalence of people unwilling to care for a child with Down syndrome, not to mention the problems that can arise when competing values clash in cases of third-party reproduction.

In a separate incident, Richard Dawkins made a tone-deaf comment on Twitter last week in response to a woman's musings about the ethical dilemma she would personally face if she was pregnant with a child with Down syndrome. His advice: "Abort it and try again. It would be immoral to bring it into the world if you have the choice."

Dawkins has since gone on the defensive and insists that his words have been taken out of context. But these remarks swell a trove of other examples of his intolerance. And his choice of words in this comment cut to the heart of the problem with prenatal genetic testing: What happens when the technology no longer enables a woman's freedom to choose, but turns into a societal pressure to have the most "normal" child possible? What happens when only certain lives are considered morally acceptable?

In response to Dawkins' statement, the UK Down's Syndrome Association put out a statement that highlights the risks of intolerance for differing ways of being, and points to a more thoughtful way forward:

People with Down's syndrome can and do live full and rewarding lives, they also make a valuable contribution to our society. At the Down's Syndrome Association, we do not believe Down's syndrome in itself should be a reason for termination, however, we realise that families must make their own choice. The DSA strives to ensure that all prospective parents are given accurate and up to date information about the condition and what life might be like today for someone with Down's syndrome.

Dawkins is not the only prominent figure to have publicly displayed prejudice about Down syndrome. In a recent piece in The Guardian, Ian Birrell recalled bioethics professor John Harris telling him on TV that it is "morally wrong" for parents to choose a child with a disability if science offers an alternative. Birrell countered:

Those preaching this new eugenics conflate health and disability, harm and difference. They dismiss how diversity enriches the world, reject complex issues of choice, ignore implications of inferiority…. This is not to quibble with any woman's sacred right to choose, merely to highlight the casual acceptance that disabled lives are second-rate and can be discarded as too burdensome.

Structural discrimination toward people with disabilities is still common. But the outrage over Baby Gammy's abandonment and Dawkins' comment provides a spark of hope. Apparently many people cherish human diversity, and reject the view that Down syndrome is something to be weeded out just because we now have a technology that could enable us to do so.

Previously on Biopolitical Times:





From “the Dangerous Womb” to a More Complex Reality

Posted by Jessica Cussins on August 21st, 2014


Untitled Document

The policing and criminalization of pregnant women’s bodies has a long history that is soaked in discrimination. Methods used have ranged from coercive sterilizations, to forcing women to give birth in shackles, to imprisoning women for taking drugs while pregnant, to increasing restrictions on women’s access to safe abortions.

The recent focus in the scientific community on epigenetics – the way in which environmental stimuli impact gene expression – must contend with the deep scars and ongoing struggles of this contentious reality.

Mounting research that suggests the importance of a healthy environment for a growing fetus, as well as throughout a person’s life, may be used in incredibly positive ways to enable much needed societal changes: For example, it can support efforts to increase access to fresh food in dismally dry “food deserts,” and to help provide non-criminalized treatment for addiction. The responsible dissemination of information can also help empower people to make better choices for themselves and their family.

But there is also the chance that this information will be brandished as shiny new scientific data to be used once again to justify only more ardent vilification of mothers and pregnant women.

A letter submitted to Nature last week titled “Society: Don’t blame the mothers,” addresses exactly this concern. The co-authors – seven academics working on the developmental origins of health and disease and the cultural studies of science – point to recent press headlines, noting how epigenetic research is already being simplistically depicted to prioritize maternal fault and under-represent compounding paternal, familial, and societal factors. 

Given that it is now known that stress and diet can cause epigenetic harm to sperm, leading to increased problems in offspring, there is certainly no scientific basis for the near-exclusive focus on women and their habits.

A Science Special Issue on parenting published last week also addresses the impact of epigenetics on offspring, but thankfully includes many different reports that portray a much more complex picture of the different ways that both parents and society can profoundly impact children’s development.

The articles cover a wide range of topics. “Parenting from before conception” takes an in-depth look at the impact of epigenomics due to the age and environmental exposures of both parents. It further discusses transgenerational impacts, as well as epigenomic variation beyond the DNA, including noncoding RNA and the mitochondria.

An article titled “An experiment in zero parenting” reports that serious neglect and lack of stimulation – as evidenced in Romania's Abandoned Children can lead to severe cognitive and emotional distress, causing long-term changes to the development of the brain and “profound intellectual delay,” though eventual care can lead to some improvement.

 “Neural control of maternal and paternal behaviors” discusses the fact that there is “a large range of intrinsic and environmentally driven neural modulation and plasticity,” pointing to how different factors impacting the neural system can lead to drastic changes in parental behavior, and again stressing the importance of parental interaction for children’s healthy development. Additionally, “The biology of mammalian parenting and its effect on offspring social development” investigates “the hormonal and neural regulation of mammalian parenting and its consequences for infant social development,” pointing to such phenomena as the activation of certain neural pathways after a child is born that encourages parents to nurture and protect their child, which in turn impacts the neural systems of that child.

Nature's first functional food” highlights how mothers’ breast milk had been a chronically under-studied super-food full of unique complex carbohydrates providing all kinds of protections for infants. “Maternal mental illness” poses hard questions about our societal priorities, pointing to the hardships that women can face in “the only developed country in the world without paid maternity leave.”

Many of the new findings reported in this special Science issue have disturbing implications for the impact of IVF and other assisted reproductive techniques on the health of resulting offspring. Here are some words of caution (extracted from three different articles) about the kinds of detrimental changes caused by manipulations involved in IVF:

1. “At least in mice, conception by IVF alters later placental and fetal development, growth trajectory after birth, and metabolic parameters and behavior in adult life.”

2. “In vitro procedures expose the early embryo to highly unusual conditions, with possible long-term health consequences as the child ages.”

3. “ART-conceived animals do appear more likely to have problems metabolizing glucose, and this effect may be transmitted to subsequent generations, probably through epigenetic changes.”

It seems clear that assisted reproductive technologies, as well as the environmental and social structures we find ourselves in, carry under-studied risks not only for our children, but for future generations. Parents-to-be deserve to know about all of these factors so they can make informed decisions about how to live their lives and raise their families. And policy makers now have the important opportunity to use this data to help create powerful changes to the structure of our society.

The fact that biology is much more mutable than we have previously believed is not only of relevance to pregnant women, but to all of us and to the society we live in. Focusing on “the dangerous womb” is far too simplistic, and a problematic omission of other compounding factors.





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