Full transcript
0:04[music]
0:09[music]
0:17Hello everyone. I welcome you once again
0:19to this course introduction to medical
0:21humanities. This is lecture 18. At this
0:24point of time, I think it is important
0:26that I mention that this is going to be
0:29part one of a lecture on understanding
0:33surrogacy and its politics. So because
0:36it deals with many issues, I have
0:38divided the lecture into two parts. Now
0:41when we think of surrogacy why is it
0:44important to be discussed in the context
0:46of India or why is it important to be
0:50discussed in the context of medical
0:53humanities. Now most of the countries
0:56across the world celebrate the idea of
0:59fertility.
1:01What does this mean? that anyone who is
1:05outside the ambit of this fertility
1:08sphere is an anomaly and therefore
1:11surrogacy works as a substitute or as a
1:15kind of uh an alternative for women who
1:18want to bear a child. Now going ahead I
1:22will quickly give you a lecture overview
1:24of this particular part. We begin with
1:26conceptual foundations of surrogacy
1:29followed by legal and regulatory
1:31provisions. We take the example of Mimi
1:34and introduce the concept of
1:36reproductive justice and talk about
1:38feminist biopolitics and how we address
1:43or we take up the issue of reproductive
1:45justice within the course of
1:47reproductive technology.
1:49Now um if you look at the ethmology of
1:52the word surrogacy, it comes from the
1:54Latin word surrogatus which means
1:57substitute. Now in the word itself you
2:01will find that it means a kind of an
2:05alternative a substitute for someone.
2:09Now in the context of surrogaci you know
2:12that it is a kind of assisted
2:15reproduction in which intended parents
2:18cannot bear a child and therefore they
2:21in very contemporary times you can say
2:23outsource uh the labor to somebody else.
2:27It is primarily a transactional deal
2:30most of the times if it is commercial.
2:32But then we also find altruistic
2:35surrogacy very much in practice. Now
2:37based on the gastational uh surrogacy we
2:40come across two kinds of prevalent or
2:43prominent surrogacy patterns. One is the
2:46altruistic one and the other one is
2:49commercial surrogacy. If you look at
2:51your screen, you will find that
2:52altruistic surrogacy discusses or
2:56altruistic surrogacy is not for
2:58commercial gains and is moralistic in
3:01essence whereas commercial surrogacy has
3:04a monetary compensation and it's a
3:06business transaction.
3:08So as an alternative when we think of
3:11surrogacy as a commercial aspect we know
3:15that there is some amount of transaction
3:18being done but altruistic is basically
3:22for helping the couple in most of the
3:25cases uh who are not having children to
3:29have their child. So you know it it has
3:31a very moral kind of an essence to it.
3:34That is how you differentiate between
3:36the commercial and the altruistic
3:38surrogacy. Moving forward these kind of
3:42arrangements if you look at will mostly
3:45need legal backing. Now why is it so?
3:47Because it involves different other
3:49kinds of uh aspects. When somebody is
3:51your child, it it involves uh looking
3:54after the child, property rights,
3:57nurturing, so many other aspects come
4:00into being. Therefore, there are very
4:02important laws that are in practice. So,
4:05if you look at the surrogacy laws in
4:07India, if you can see on your screen,
4:10before 2002, there were no formal
4:12guidelines.
4:14So if you ask maybe somebody in your
4:17family very elderly they will tell you
4:19about how surrogacy patterns happened.
4:22It was mostly within family where a
4:25couple who was not having any child
4:27there was somebody in the family itself
4:30who would bear a child for them and give
4:32it to them. That is how mostly the
4:34arrangement worked and there are many
4:36examples you can see around that and uh
4:39you will find the reflection of it also
4:42in the literary and filmic texts.
4:46However, during 2002 to 2005 you find
4:50that ICMR and Ministry of Health
4:53approved art guidelines and commercial
4:56surrogacy became
4:59possible in the context of India. Now
5:01altruistic surrogacy you must also
5:03understand had a lot of problem because
5:06it was within family uh there were not
5:09just family issues but there were also
5:11medical is issues related to that. So
5:13that became a little bit of problem and
5:15hence a clear guideline came in uh 2002
5:19to 2005 about commercial surrogacy being
5:22allowed where people could kind of uh
5:25hire a surrogate and uh have a child.
5:30But there are two cases which are very
5:33prominent which became very
5:34controversial. The case of baby mangi
5:37and jalbalas which I will discuss in the
5:40next uh part uh they became very
5:42high-profile cases and exposed ethical
5:46loopholes. Now at this point of time you
5:50must understand that the entire space of
5:53commercial surrogacy had become a little
5:56murkier. Now why it became murkier?
5:58Because of the economic disparities in
6:01in Indian context. There were many women
6:04who were bearing the child again and
6:06again. Uh there were brokers who were
6:09giving them less money and maybe uh uh
6:12you know getting more money. The
6:13hospitals and clinics were making more
6:15money out of it. Sometimes when the
6:18anomaly scan showed uh a baby with some
6:20defect the couple the commissioning
6:22parent would run away. So there were
6:24many things happening and that is the
6:26reason in 2021 2022 we had this
6:30surrogacy regulation act that banned all
6:33kinds of commercial arrangements in the
6:36context of India. At that point of time
6:38there are several researchers that will
6:40tell you that India had became a tourism
6:44I mean a kind of a reproductive tourism
6:47country where there was immense amount
6:50of commercial surrogacy happening
6:53especially some parts of India became
6:55rife with such cases. So no uh wonder
7:00that law had to intervene because they
7:02realized that it was a very uh crucial
7:05space of exploitation and hence we find
7:08the surrogacy regulation act 2021 come
7:10into place and banning commercial
7:13surrogacy and only altruistic surrogacy
7:15is now legally possible in the context
7:18of India. Moving forward then what is
7:22possible in surrogacy regulation act
7:252021?
7:26uh you see that there is a clear-cut
7:30criteria maintained for who is eligible
7:33surrogate and who uh who will be the
7:36commissioning parents. So in in the
7:40context of surrogates the age limit came
7:44first and also the marital status. So in
7:48terms of age they could be somewhere
7:50between 25 to 35 on your screen
7:53everybody [snorts] and they have to be
7:55married. So this was an important
7:58criteria followed by another important
8:01criteria in which you could only become
8:04a surrogate if you had your own child as
8:07well. So that was another point that was
8:10considered to be important because you
8:13know if you do not have your own
8:14children then maybe it becomes a problem
8:17later on what if you claim some kind of
8:19ownership so I mean law decided that no
8:23it is not going to be like that they
8:24must at least have one child and only
8:26then they can bear somebody else's child
8:28as a surrogate
8:31also important was the
8:33how many times they can bear a child so
8:36that also So the law decided it said
8:39only once in a lifetime. So it's not
8:42like your body could become a machine of
8:45producing babies. Uh you had only one
8:48chance even as an altruistic surrogacy
8:51practitioner. You only had one chance to
8:55bear somebody else's child as a
8:56surrogate. [snorts] And fourth and most
8:59important you had to be medically and
9:03psychologically fit. Now you must note
9:07at this point of time that mental health
9:09care act came in 2017 and with the
9:12global health guidelines mental health
9:15is something that you will always find
9:17mention of in most of the acts that have
9:19come later on clearly emphasizing the
9:22fact that health is not just physical it
9:26is also mental. What was the criteria
9:29for eligible intending parents? they
9:32must prove medical infertility.
9:35I mean they had to clearly indicate
9:38through certificate uh that they could
9:41not bear the child. So that was the
9:43first criteria that was uh decided. The
9:47second one was around married Indian
9:50couples or widows or divorces.
9:54very clear-cut idea around the
9:57institution which supported
10:00them to hire a surrogate. So as a family
10:05you should have at least you should have
10:08been married either or you should be a
10:11divorcee or a widow. So you know those
10:14kind of very clear-cut guidelines were
10:16laid out and the age was also decided 35
10:19to 45. So you see the intending parents
10:23could be 35 to 45 whereas the surrogate
10:26could be 25 to 35. The 2024 amendment
10:31also has happened in which donor gamuts
10:35allowed if a medical board certifies a
10:37partner's medical request required. So
10:40even other amendments were made and what
10:43primarily this act did was it said no to
10:47commercialization,
10:49sex selection, embryo trade and any kind
10:52of exploitation. So that was a big no
10:56no. So in that sense surrogacy
10:58regulation act 2021 is a very
11:01revolutionary change in the space of
11:04infertility treatment in Indian context.
11:08Moving further, we discuss a little
11:11later a film called Mimi uh which came
11:14around the same time. But you at this
11:17point of time what I want to highlight
11:19is the fact that
11:21there is law and I have discussed it
11:24earlier also but the implementation of
11:27the law has to take place in society.
11:30there has to be a kind of a balance that
11:32gets struck between society and the law
11:35because it is ultimately the society
11:37where the implementation is taking
11:39place. So that is very well reflected in
11:44this particular film. If you look at the
11:46film, the film basically focuses on Mimi
11:50who is a surrogate. Now the intending
11:54parents are a couple from the west and
11:58it clearly shows the
12:02asymmetry between global north and
12:05global south cultures.
12:07It also discusses how
12:11the interest of mimi in this case is
12:14purely driven by the financial
12:18transaction that is going to happen.
12:23But when you see the entire film, the
12:26way Mimi's journey is happening
12:30throughout the film, you notice that
12:33basically it's a story
12:36to go beyond to see surrogacy beyond the
12:40glittery aspect and what is in the film
12:44considered to be once in a lifetime
12:46opportunity.
12:47The film explores very emotional and
12:50deeper side of being a surrogate and the
12:53entire process in which surrogacy works.
12:58Additionally, while the system views
13:01surrogates as womb for rent, a very
13:03common term used in surrogacy which is
13:06called womb for rent. The voices and the
13:10ambitions reveal intricate histories of
13:13women and families seeking to enter the
13:16global market on the most favorable
13:18terms imagined. So there is a clear-cut
13:23bargain. You will see even in this film
13:25how it happens in uh for Mimi where she
13:30basically
13:31goes on to become a surrogate because
13:34she's an aspiring actress. She's in a
13:36small town in Bikananeer but she wants
13:38to go and uh pursue her career in
13:41Bombay. Clearly indicating now that many
13:46times you know law makes some kind of
13:49rules which are important but they are
13:52policy decisions indeed but it is
13:55through films you feel those issues the
14:00gaps somewhere which is between the
14:03implementation and making of the law.
14:06The films make you realize that and Mimi
14:08is one such good example. Let me go
14:12ahead in a little detail of what you see
14:15on your screen. There are three
14:16prominent characters. Now in the
14:18surrogacy pattern, I told you there are
14:21commissioning parents which is intended
14:23parents and there is a surrogate. But
14:26then there is also another person which
14:28is important which is the broker. Like
14:31most of the clinics or hospitals do not
14:35deal with surrogates directly. The
14:38hiring process takes place through a
14:40broker. In this case, you will find
14:44Bhanu Bankraati as the broker. And if
14:47you look at some of the some of the
14:49details that I mentioned on your screen,
14:52you will find that Mimi is the womb. The
14:56womb that is going to be rented. Bhanu
14:59is going is the broker. He is going to
15:03hire a womb for whom? John and Summer
15:08who are the commissioning parents. Now
15:10once these three parties are clear in
15:12your mind, how do we go about? We talk a
15:16little bit about them. So Mimi is a
15:19dancer in Bikan and she's seeking funds
15:21for Bollywood aspirations. She wants to
15:24become an actor. There is no money.
15:27Bhanu's job is that he's a driver turned
15:29mediator who identifies the asset and
15:32negotiates the contract. So Mimi is an
15:35asset. A womb for rent is an asset. So
15:38he does that. And John and Summer who
15:41are an American commissioning couple
15:44seeking a womb that they can outsource
15:47to get a baby. Now once the film opens
15:51you find that it is a very normal
15:53conversation happening. So it kind of
15:55normalizes surrogacy in that sense and
15:59Banu meets Mimi. He thinks that she's
16:02quite capable of becoming a surrogate
16:05and therefore he proposes that to her.
16:08Now how does that transaction happen?
16:10How does that conversation happen? That
16:12is also very interesting.
16:14Now uh again both of them are discussing
16:19and uh if you look at some of the
16:21dialogues here the
16:25last one we will begin with h I mean the
16:28time when Mimi is convinced of becoming
16:31a surrogate she says I am already 25
16:34years old if I wait any longer they'll
16:38ask me to play a mother myself I need to
16:41become a mother now to avoid playing one
16:44on screen. So you see the kind of
16:46desperation
16:48uh there is. It's like I have got an
16:50opportunity and uh I am already 25 years
16:54old. I must rush take this opportunity
16:56and go become uh an actress which is my
16:59ambition. Before that what happens is
17:02that Bhanu who is the broker he
17:06discusses this opportunity with her and
17:09says that you have to take this
17:12opportunity as a lifetime opportunity
17:15because it it will provide you the
17:17required amount of money that you are
17:20willing to have to go to Bombay. Now
17:24Mimi is very convinced around this idea
17:27because she's in desperate need of that
17:29money. What does this mean? This means
17:32that commercial surrogacy or what you
17:36call the reproductive tourism actually
17:38is a very tempting offer because for
17:41many people who are living in these
17:44vulnerable spaces
17:46it's it promises a lot of money and
17:50therefore
17:52this opportunity for Mimi too becomes a
17:55no exception.
17:59See this metaphor here. So when Bhanu is
18:03explaining now Mimi is very surprised as
18:05to what has happened u if I become I
18:09don't have to marry I don't have to uh
18:11do anything what is it that will happen
18:13so he explains now the explaining
18:17is also very Indiaentric so and the
18:21metaphor Bhanu chooses also is very
18:23appropriate here because in India
18:25agriculture is known to everybody and
18:27that is why he uses a very agrarian kind
18:30of a metaphor.
18:31He uses kith which is farm, bead which
18:35is seed, gara which is sugar cane. Now
18:38what does he say? He says that you mimi
18:42are like a barren land.
18:45So somebody will lease your farm
18:50and the foreign embryo will be planted
18:54with manure. So that is how he explains
18:58and then he says the product will be a
19:00sugar cane. So the baby becomes the
19:02product. So when Bhanu explains
19:05surrogacy through agrarian metaphors
19:08which is kith beach and ga stating that
19:12summer's land is barren so she will
19:14lease her farm and once the seed is
19:17planted mimi must hand over the sugar
19:19cane your womb their child. That is what
19:23Bhanu explains. So what it does in the
19:26film is that it turns
19:29Mimi's womb into an infrastructure
19:33and in infrastructure for commissioning
19:35parents which can be leased, monitored
19:39and harvested through a service
19:41contract. So you see that this
19:44transaction that is happening in Mimi is
19:47not new. It is one of the instances.
19:50However,
19:52even something that looks like a choice
19:54Mimi makes, feminists like Bradoti and
19:58all have claimed that these reproductive
20:02technologies reinforce an ultra
20:05heterosexual understanding of the
20:07nuclear family. What does this mean?
20:10that within the
20:14space of even commercial surrogacy they
20:17turn this into logistics and motherhood
20:21into deliverables.
20:23So it's very problematic
20:25because
20:27this whole concept is only for
20:29heterosexual couples. That is what is
20:32also discussed in the law. And if you
20:35look at the scene that is on your screen
20:37right now. So she asks someone uh she
20:40asks Bhanu uh so I won't have to sleep
20:42with anyone. So he says no. So very
20:45clear-cut idea of what surrogaces is to
20:48be like is in her mind till what we
20:52discuss later on happens.
20:56I will at this point of time discuss
20:58some of the feminist debates on
20:59reproductive technologies because
21:02usually with technology we think that
21:05technology is very liberating.
21:07Technology assists but technology can
21:11also be
21:13a tool for subversion. That is a point
21:17this film tries to make. But before that
21:19let us take what Schulamit Pstone talks
21:22about technology. She says it is a kind
21:25of reproductive enslavement advocating
21:28the seizure of the control of human
21:32fertility through artificial wombs and
21:34even bottled babies.
21:38Now while technology came up to address
21:43the issue of fertility and it is
21:46primarily to help the parents who do not
21:51have children to have a child.
21:54The process in which
21:57commercial wombs are hired becomes
22:03political in the sense that there is a
22:06control that is exercised on the woman's
22:09body. In the bio capitalist medical
22:13industry, wombs then become equivalent
22:17to hatcheries, plumbing or rented
22:20property. So if you trace this with the
22:22law, the fact that one can only become a
22:25surrogate once is because of this
22:29phenomena. Women treat themselves as
22:34you know hatchery go on producing babies
22:37and sometimes there is also a kind of a
22:40coercion that can happen there. So it's
22:42not important that every time they are
22:44making a choice even the vulnerability
22:49economic vulnerability leading to making
22:51that choice is a kind of compulsion that
22:54is happening something that bio
22:56capitalis model does not realize. Now
23:00womb is also seen as an incubator and is
23:03alienated from the women. Uh so
23:08when you rent a womb it's said that it's
23:11independent of the person
23:14and it has a very strong detach value to
23:18it and that is probably ren rendering
23:21zero value to her moral or physical
23:24well-being. So uh I mean uh there are
23:27quite a few novels that talk about
23:29surrogate experience in which they say
23:31that once they were pregnant with their
23:34own child probably they did not get any
23:37uh sufficient well-nourished food or
23:40fruits or anything else. But what
23:43happens now when they are surrogates
23:45they are treat taken to doctors every
23:48month or um whenever they need medical
23:51checkup is happening their health is
23:53monitored. So you know they even that
23:57kind of creates a space in which they
23:59realize that the economic space that
24:03childbearing also has an economic value
24:06to it. So Damita Pandi talks about it uh
24:09in great detail. Finally we discussed
24:11Sara Franklin who expressed that
24:14unrestricted access to use of RT would
24:16result in the exploitation of breeder
24:18women and the poorer countries would
24:20become reproductive brothel. So again if
24:23the commercial surrogacy is rampant uh
24:27what it is doing primarily is that it is
24:29catering to the west an idea that is
24:32very problematic not only in its
24:35implementation but also as a source.
24:38So if you look at uh this particular uh
24:41uh slide you will find that in Mimi uh
24:46everything goes very well. The
24:48commissioning parents are very happy and
24:51uh Mimi has agreed till there is an
24:54anomaly scan that says the child has the
24:58possibility of having a defect. That is
25:00what anomaly scan says and the
25:03commissioning parents are just gone. Now
25:07it is an unmarried girl who is left with
25:12a child in her womb. So she's pregnant,
25:15she's single. So single and pregnant in
25:20India it has a lot of cultural uh
25:22contour shame attached to it. So now she
25:24doesn't know and once these parents have
25:27gone
25:29she doesn't even know if she can abort.
25:33So it's a clearcut dilemma that Mimi
25:39you know depicts of. So there is stigma,
25:44there is legal threat, there is medical
25:47authority and there is family or honor
25:50and in between there is mimi.
25:54So while
25:56there are choices that she can make, you
25:59come across a situation in which out of
26:03many shames and stigma that she can
26:05choose is that she has to keep her baby
26:09because she prioritizes
26:12the motherhood angle over everything
26:15else. And therefore when you read this
26:20decision through the lens of Michelle
26:23Fuko you find that it reflects
26:25biopolitics where power regulates body
26:29and reproduction through institutions
26:31such as law, medicine and social
26:33reforms. So the choices that appears to
26:37be yours are actually driven by all
26:40these other factors that controls your
26:43body and therefore you uh when in the
26:46towards the end you find the
26:48commissioning parents have come back
26:50Mimi keeps the baby it's a fair baby
26:53that has been born absolutely uh normal
26:56in this able-bodied term and u very fair
27:00and she's very happy and then in the
27:02last the commissioning parents come and
27:04claim for the child. And to which Mimi
27:07responds,
27:27which loosely translates as a rebuke.
27:31She's saying that there was no fault in
27:34the child. The fault is in your
27:35mentality and you were at fault because
27:38you left somebody with your child in
27:42someone else's womb. So that is the kind
27:44of uh space Mimi addresses because this
27:49space of exploitation is rampant in also
27:53anthropological research. You will find
27:54many researches that have been done uh
27:57in in India in very empirical in nature
28:00where commissioning parents had just
28:02vanished.
28:04Uh therefore what happens surrogacy
28:06becomes a labor a sexualized care work
28:11and the surveillance of global power
28:13politics works in such a way where you
28:16find that the sexuality of a woman the
28:19sexual labor of a woman is more nuanced
28:23analysis than one based solely on
28:25morality. So it's not just morality
28:27based but it is more nuanced than that.
28:30You also find that the religious framing
28:34around
28:36surrogates being sold as god-given
28:38opportunity which means that you help
28:40them uh or a sign from God in in u the
28:44film also Bhanu says it's a sign of from
28:46God that you are going to help somebody.
28:48So it becomes a matter of resource for
28:50the commissioning parent. That is how it
28:53is visualized. The body is not only a
28:55site of care but also a site of
28:57discipline because the resource is
29:00worker's body itself and it invites
29:03definitely monitoring of some kind or
29:06other management and depending on who is
29:11bargainaining the power in terms of
29:14class in terms of decision making and in
29:18terms of economic autonomy.
29:21Uh finally uh when you look at many of
29:24these cultural scripts you find that the
29:30attribute that is assigned to Mimi is
29:34the glorification of motherhood the maki
29:37ma
29:39and uh that is what you see in reviews
29:42also. So I just put out two reviews here
29:46where it says Maki Ma mother's love next
29:50right now I plan on changing his
29:52diapers. So when in the film Mimi is
29:55asked as to what she's going to do now,
29:59what happens to her aspiration of
30:01becoming an actor now that she's a
30:03mother uh to a small child? What is she
30:06going to do? She says that right now I'm
30:08just thinking of changing the diapers.
30:10I'm not interested in anything else.
30:13This is my priority. So this also is
30:16shown in the film where motherhood
30:18dominates all other narratives and she
30:20uh just shuns her career ambitions to
30:23become a very good mother. The other
30:27aspect which I also found a little uh
30:30problematic in the film but it's
30:32definitely worth mentioning is colorism
30:35in the market. Now why I pick up this
30:38because the film makes it a point to
30:42also highlight the color of the child.
30:45The in the film there is a particular
30:46dialogue which says
30:52which is which can be translated as no
30:54other child in this city is as beautiful
30:57as this one. And this again this again
31:01reflects that
31:03we are still obsessed with the fair skin
31:06and because it's such a beautiful child
31:08it's uh it's it's wanted again an
31:12able-bodied narrative which is slightly
31:15problematic but this film is not about
31:17that I just thought I'll make a mention
31:19of it but primarily about the space of
31:22exploitation primarily about how body
31:24becomes a site of control and
31:26surveillance is something that I wanted
31:27to highlight Even within the space of
31:30surrogacy which otherwise looks like a
31:33very moral uh space of helping somebody
31:37uh who is not able to bear a child in
31:41the larger narrative of fertility and uh
31:45glorified parenthood.
31:47Finally uh we take up the reproductive
31:50justice discourse quickly I will tell
31:52you uh here uh but I will take take it
31:54up in great detail in the part two of
31:57the lecture. So reproductive justice
31:59primarily says that in the absence of
32:03the resource rights are not possible and
32:06therefore
32:08while we claim that there should be
32:10reproductive rights if there are no
32:13resources available there is no access
32:15to resources the rights become nil null
32:20and void. Uh I will discuss this in more
32:23detail when we go to the next part of
32:26the lecture. I begin with the
32:28reproductive justice framework and this
32:29is where I will stop and take up take it
32:32up in the part two of uh surrogacy uh
32:37discussion. Thank you.