The Baby Chase

How Surrogacy Is Transforming the American Family

Leslie Morgan Steiner

St. Martin's Press

Part 1
 

What’s the Big Deal About Not Having Babies, Anyway?
 
 
Mother’s Day, 2011. In the golden twilight of her cactus-studded front yard in Mesa, Arizona, forty-year-old Rhonda Wile looked nothing like a woman who had endured six harsh years of failed fertility treatments. One surprise vasectomy. One heartbreaking miscarriage. A painful divorce. One suicide attempt.
Most of all, Rhonda looked absolutely nothing like a woman who, after years of despair, was finally expecting twins in August.
Instead, sipping iced tea in the auburn shimmer of the sun setting on the desert, Rhonda Wile looked like a stunningly attractive-yet-approachable young wife posing for a Cialis or Viagra commercial. She wore a red cotton V-neck shirt and crisp white shorts that accentuated her trim, hourglass waist. Her long blond hair was glossy and thick. She appeared surprisingly well rested for a nurse who had just come off a twelve-hour shift. Over five feet seven inches tall, with a striking, curvaceous figure and a friendly grin, she smiled with the warmth of a woman not overly aware of her charm.
Despite the fact that she’d spent Mother’s Day working her usual 8 A.M. to 8 P.M. schedule, Rhonda radiated optimism like a halo. Rhonda had spent most of a decade mired in fear that she’d never join her sister, mother, and childhood friends in that most exclusive club: motherhood. These days, she mainlined hope like a drug—even when she shopped at Target, changed an IV drip at work, or slept at night next to her husband of eleven years.
This Mother’s Day, for the first time since being a child, hope felt like an emotion Rhonda could count on.
As a nurse, Rhonda knew, objectively at least, that her mad, burning desire to have children sprang from the universe’s most powerful biological craving: to create life. Perpetuation of our species is the instinct behind our sex drive, the logic behind sexual attraction. Nature wants us to give in to both urges, the sexual impulse and the deep craving to have children.
That intellectual understanding did not make Rhonda long for children one iota less.
Gerry Wile, Rhonda’s husband of more than a decade, had stayed home on Sunday while Rhonda worked. A Maricopa County firefighter, Gerry was a six-foot-tall, broad-shouldered, heavily muscled, former military man with a buzz cut. He, too, looked straight out of central casting, the type of handsome, rugged man who revs a Dodge Ram pickup truck through a muddy ravine, smiling reassuringly as dirt spews out from the mammoth back tires.
Gerry was barefoot and shirtless in the dry Arizona heat, watering the cacti and walking with the light feet of a quarterback. His body was accustomed to jumping out of airplanes and carrying 110-pound, five-inch-diameter hoses from his fire truck directly into the wildfires that raced through the desert brush. Laugh lines were etched into his sunburned cheeks. He was a guy who, while hauling you safely out of a burning building, would crack a joke to make it seem like you’d come through a memorable adventure, not a near-death experience.
The fading Arizona sun showed off the butterfly tattoo on Gerry’s ripped right calf. On his left rib cage, there was another design, large and intricate enough to rival Lisbeth Salander’s famous dragon tattoo. The ink depicted a huge elephant head. It was an elaborate representation of Ganesh, the Indian god devoted to removing obstacles. The elephant head was overlaid with two tiny baby footprints, the type you see stamped onto a hospital birth certificate.
Strange ink for a forty-four-year-old fireman and military veteran.
As a firefighter, Gerry knew that the desire to nurture and protect children was nearly as powerful as the urge to create them. Nothing generates more adrenaline in firemen than children’s toys scattered on the porch of a burning home with a family trapped inside. This is also a biological imperative of our species, because as any firefighter knows, human infants are among the most helpless offspring in the animal kingdom.
For most parents, as for most firefighters, the instinct to protect children outweighs even our instinct for self-preservation. Even though we sometimes cannot stand our own kids. Even though no one, not even Rhonda or Gerry, wants to sit next to a crying baby on an airplane, few parents would hesitate to run into traffic—or a burning building—to save a child.
All just as nature intended.
Rhonda and Gerry knew the U.S. Department of Justice statistic that every year in the United States over 100,000 children are abducted. A distinctly unnatural desire: to steal someone else’s child. Imagine what you would do if your child were kidnapped, if a force outside your family, someone with no interest in how deeply you love your child, had the ability to destroy your family, your biological link to eternity.
How much would you pay to rescue that child?
How far would you travel?
Would you ever abandon the search?
Rhonda, sitting on her brown living room sofa with Frankie, her white shepherd-Catahoula pooch, often watched America’s Most Wanted on television alone during the long evenings when Gerry worked overnight shifts at the firehouse. From the show, she had learned the comforting data that, fortunately, the vast majority of abducted children are found within hours. Only roughly one hundred kidnappings a year result in the death of a child. It consoled Rhonda to know that few parents understand this misery firsthand.
However, Rhonda and Gerry understood all too well an anguish nearly identical to the trauma of losing a child. Failure to conceive or give birth to a baby is a kidnapping of a different variety. Over the course of their eleven years together, Rhonda and Gerry’s dreams had been stolen. It didn’t matter that their lost children were never born.
Every year in the United States, an astonishing number of children—more than one million babies—are lost to infertility and miscarriage. These losses don’t make national headlines. At times, even best friends and close family members never learn of them.
Yearning for a child—and not being able to have one—represents an ache that is complicated to capture or measure, even for sufferers and fertility doctors. For some, to die without creating life adds up to two deaths: one’s own, and the opportunity a child represents to defy mortality.
“It feels like constant starvation,” says Rhonda Wile, speaking slowly, searching the cobalt desert horizon outside her home like a crime victim trying to recall an assailant’s features for the precinct sketch artist. “You’re hungry all the time, even when you’re sleeping. You gradually understand that you are going to be starving, starving for a child, for the rest of your life.”
How far would you go to have a child?
Would you harvest your eggs or sperm at age twenty-two, your fertile peak?
How many rounds of long subcutaneous needles, hormones flooding your body, and invasive, expensive surgeries would you endure?
Where could you find the money? Would you sell your car, your house? Ask your parents to hock their retirement condo?
What would you do to help someone else have a child? Write a character recommendation for an adoption agency? Lend a friend money? Donate an embryo? Carry a stranger’s baby in your uterus?
Picture that you’d spent your life savings on in vitro fertilization (IVF) and other fertility treatments, and you still didn’t have a baby. Could you make one final reckless gamble? Would you be able to find the nearly $100,000 needed to finance the most desperate solution: paying another woman to create and carry a baby in her uterus for you?
At forty, nearing the end of her fertility road, Rhonda knew the answer. She and Gerry, after trying to get pregnant dozens of times, dozens of different ways, had found a radical new solution.
Rhonda and Gerry had spent nearly $50,000 trying to have children together, more than they spent on their house down payment and the purchase of their two cars. Rhonda and Gerry’s baby chase had led them thousands of miles from home, to a perplexing, entrancing country with over 11 million unwanted infants and one of the highest female illiteracy rates in the world. They’d ventured to a faraway land they had never once dreamed of visiting, all in search of a baby they could afford on a nurse and firefighter’s income.
The reason Rhonda looked so svelte was simple.
Although she and Gerry were expecting twins, Rhonda was not pregnant.
The unborn twins were Rhonda and Gerry’s babies, but they were not growing inside Rhonda’s body. Another woman was pregnant with Rhonda and Gerry’s twins. Her name was Gauri.
A dozen times a day, while Gauri went about her chores, when she heated water for breakfast tea for her husband, or scrubbed her children’s dark blue school uniforms, the thought jerked Gauri like a truck horn suddenly blaring in the night: she was pregnant from a twenty-minute medical procedure, without having had sex with the baby’s father. The babies she had carried for five months had been created from another woman’s egg and a stranger’s sperm; she had no genetic connection to them. And she was going to become rich beyond her wildest dreams in exchange for growing these babies for two people she had never met.
Her body. Their babies.
The Wiles knew Gauri’s height and weight, the ages of her son and daughter, her husband’s income, what she ate for breakfast, and the results of her latest blood draw. But they had not met the woman carrying their babies. In fact, they had never even talked to her. Gauri didn’t speak English. Plus she had no telephone. Finally, the woman bearing the Wile twins lived twelve time zones and 8,847 miles away in a small temporary apartment in the Bhandup West neighborhood of Mumbai, India.
“Which made it kind of hard for the three of us to catch up,” says Rhonda today, with a rueful smile.
*   *   *
Having a baby is natural, right?
Also as natural—and as ancient—as the human species itself is difficulty conceiving and carrying babies. Long before words were written on papyrus, or horses painted on Paleolithic cave walls, long before doctors understood what causes infertility, and centuries before birth control and women’s rights advocacy enabled women to delay childbearing, infertility afflicted humans at a steady rate of 10 to 12 percent.
Surprising, then, that studies have shown that almost all women wildly overestimate our ability to get pregnant, at every age, and to have as many children as we want in our lifetime. Infertility is one affliction no one talks about, or assumes will happen to them, until it actually happens to them.
Throughout time and in every culture, women like Rhonda Wile have erroneously borne the burden of blame. The inaccurate historical assumption has long been that infertility was strictly a women’s issue. In the Old Testament, written sometime in the fifth or sixth centuries BC, Abraham’s wife Sarah was barren until a miracle son, Isaac, was born long past her childbearing years. In Genesis, the Lord closed Rachel’s womb until she cried out to Jacob, “Give me children or else I die.” Michal, the daughter of King Saul; Hannah; Elisha; Samson’s mother; even the Virgin Mary’s mother, Anna, and her cousin Elisabeth, all were labeled “barren” women who could not bear children.
The Bible never refers to any men as barren. U.S. history books rarely note that the father of our country, George Washington, was not an actual father. He created no offspring, despite marrying a demonstrably fertile young widow, Martha Dandridge Custis, who had given birth to four children with her first husband by the time she turned twenty-five. Today’s infertility specialists suspect that Washington suffered from Klinefelter’s syndrome, an affliction with symptoms including bad teeth (Washington lost his by his early twenties), unusual height (he was six foot three), and sterility.
Human understanding of male infertility came only with twentieth-century medical technology. The reality is that for 30 percent of cases, experts don’t know what causes the inability to conceive. In couples where doctors can pinpoint the origin, 50 percent of problems lie with the man.
Bias lingers nevertheless. Many cultures continue to shun women when a couple experiences sterility. Many women, in the United States and other countries, blame themselves if they have difficulty getting, or staying, pregnant. An accepted solution in many cultures, cited over twenty times in the Old Testament, was for men to turn to other, potentially more fertile, women to try again, sometimes with legal and societal sanction. An ancient, respected form of surrogacy.
Hiring a surrogate is now, in certain circles, a badge of hipness. Trendsetters today make magazine covers with their surrogate babies. Nicole Kidman. Elton John. Sofia Vergara. Angela Bassett. Neil Patrick Harris. Sarah Jessica Parker. They all have beloved babies born from other women’s wombs. Among the less famous, an amazing 2,000 to 4,000 babies are born each year to surrogate mothers to whom they have no biological connection.
In short, infertility has been a reality for the human race, disproportionately affecting women, for centuries. And surrogacy has always been one of the solutions.
What’s wrong with not being able to have babies, anyway?
You could save a lot of money on birth control and diapers.
With seven billion people, who needs more children in the world?
Maybe infertility is God’s way of controlling the population.
Why don’t you just adopt?
Try telling that to anyone who wants a baby.
Few parents would limit how much they would sacrifice for their children. To anyone with a child, this seems indisputably true. Children are priceless.
Especially to people who cannot have them.
*   *   *
Unless you’ve experienced infertility firsthand, it seems an uncommon affliction. It’s definitely not a “disease.” When infertility strikes a friend or a celebrity on the pages of People magazine, the inability to conceive is easy to brush off as fate. God’s brusque message that, Sorry, kids are not in the cards for you. Few beyond the infertile know the causes of sterility or its commonality. Infertility remains a hidden, taboo disease, with corrosive psychological effects on individuals, couples, and families.
Yet people seeking treatment spend $10 billion a year globally in search of a positive pregnancy test. In the United States alone, $5 billion is spent every year by sufferers willing to pay almost any amount to create a child.
If you have been touched by infertility, your understanding deepens immediately. Dr. Robert J. Stillman from the Shady Grove Fertility Center outside Washington, D.C., has spent most of his sixty-four years immersed in the agonies of infertility and the joys of treating it successfully. He is one of thousands of doctors today who dedicate their entire careers to assisted reproductive technology.
“Are children a gift?” Robert Stillman asks rhetorically, looking around his office crowded with medical charts, pictures of the Grand Tetons and Utah’s Anasazi Indian cliff dwellings, and a large, powerful Dell computer, as he struggles to explain the desire to have children. In a way, this same drive—to help infertile couples—has gotten him out of bed, and in front of a classroom or a patient, each morning for over forty years.
“No. Not just a gift. Are children a human right? No. Not just a ‘right.’ Children are a biological necessity. Making babies is why we human beings are here on earth. Procreating is the number one biological imperative for our species. Infertility is a disease, like cancer. Treating infertility helps the human race survive. Helping someone have a baby does not hurt anyone—you are not taking a baby away from anyone else. Asking people who want to have children not to have children is cruel, inhumane, and against the natural, Darwinian survival of ourselves. In the most fundamental way, treating infertility is as pro-life as you can get.”
Today’s range of fertility treatments has transformed what a diagnosis of infertility means. What’s different now: infertility is treatable. Medical and societal innovations expand the baby chase every day. Determination and outrageously expensive, sophisticated treatments have taken the place of quiet, lifelong anguish, despair, and disappointment.
Even so, some couples facing infertility give up their dream of having a baby. The loss can embitter their lives until the end, a grief too great to be borne gracefully. Others accept and embrace childlessness, finding that a child-free life offers its own peace and reconciliation.
Once the infertility highway narrows to what feels like a dead end, some people who still really, really want a baby start contemplating two ideas they may have hoped they’d never be forced to consider.
One is accepting that adoption, despite the competitiveness of modern adoptive procedures, and costs that can exceed $60,000, may be the right way to build a family.
The other, increasingly popular response is to hire a woman to create and carry a baby for you.
This radical solution—surrogate pregnancy—to some seems the domain of science fiction, conjuring Margaret Atwood’s 1985 dystopian novel The Handmaid’s Tale, where young, fertile women are forced to gestate babies for older women. However, fundamental advances in medically assisted reproductive technologies, particularly in vitro fertilization, have made surrogacy simultaneously easier, and more complex, than at any time in history.
Today, nearly anyone—single, married, gay, straight, sexually active, a virgin, or a nun—can have a baby. Anyone. One way or another or another.
Assuming, of course, that they can afford it. Because hiring a surrogate can run north of $100,000. In the United States, at least.
Every child is precious. That doesn’t mean that everyone can afford one.
*   *   *
In 2011, Rhonda and Gerry Wile were finally building their family, utilizing methods unavailable to their own parents merely a generation before. However, it certainly felt unusual, to say the least, to have their babies growing in another woman’s body two continents and eight thousand miles away. Their siblings, cousins, and best friends all had their babies at the local hospital. Still, Gerry and Rhonda counted themselves lucky.
Years before they first boarded a plane to India in search of a baby, though, they had had to learn more than what 99 percent of parents on the planet know about surrogacy, sex, and conception.
“It wasn’t easy,” explains Rhonda today.
First, the Wiles learned, mostly through hours of Rhonda’s late-night online research, that surrogacy is legal only in some countries and certain states. Unpaid “compassionate” or “altruistic” surrogacy, often involving a friend or family member who carries a baby when someone she loves cannot, is possible, but rare. More common and quickly growing in popularity is paid, or “commercial” surrogacy.
Surrogacy—once the Wiles absorbed the audacity of it, the legal, medical, and insurance risks, the peculiar queries and emotional reactions from family and friends—offered the exhilarating possibility that Rhonda and Gerry could have a baby, a baby that felt like theirs from the moment of conception.
No home visits by adoption social workers. No grueling, invasive applications. No birth mother who might change her mind quixotically at any moment.
No questions from their child, at six or sixteen or sixty, about why her “real” parents didn’t want her. A baby that would be theirs, forever, from the instant Rhonda and Gerry heard its heartbeat on the six-week sonogram. A baby no one could take away.
“Our baby,” says Rhonda, making the two words sound priceless.
What the Wiles found equally breathtaking—and heartbreaking—about surrogacy was its cost.
Rhonda drew in a harsh breath the night she totaled the amounts on her computer calculator. Several articles and blog entries quoted a fee of $25,000, paid directly to the surrogate. Plus the surrogate’s medical and living expenses for one year. Plus the hospital delivery costs.
Plus lawyers’ fees to draw up a surrogate contract and adoption papers for the Wiles to legally adopt their own baby once he or she was born. Plus additional travel costs, since as far as Rhonda could tell, most American surrogates lived in Pennsylvania, Colorado, Maryland, and California, all states that were very supportive of assisted reproductive technology (ART).
Then Gerry reminded Rhonda: she needed to factor in hormone injections and egg retrieval and embryo transfer costs for herself and the surrogate.
She came up with a conservative estimate: $80,000 to $100,000. If nothing went wrong. If the surrogate did not deliver early. If no one—not the surrogate, not the state, not the hospital—disputed the surrogacy arrangement.
One hundred thousand dollars to have a baby?
“So, for me and Gerry, the question wasn’t ever, ‘How much is a baby worth?’” Rhonda says now, years later, still trying not to tear up. “The question was actually, unfortunately, so much more crass. The real question was ‘How much could we afford to pay for a baby?’”
This is a question no one should ever be forced to answer.
Rhonda would have paid $1 million for a baby. She would have sacrificed anything. But this nurse and firefighter were never going to come up with $100,000.
*   *   *
On a blue-sky afternoon in early November, a few days after Halloween, yellow leaves and a few Reese’s candy wrappers littered the cobblestone sidewalks ringing the Maryland State House. The circa-1772 redbrick, white-columned Annapolis landmark is the oldest American edifice still in legislative use. Our infertile founding father George Washington resigned his military commission here in 1783. Three years later, patriots rallied in the State House to call the thirteen American colonies to assemble for the Constitutional Convention. Another 225 years later, red, white, and blue American flags, as well as Maryland’s black, gold, and red ones, fluttered at every window.
On the third floor of a small, anonymous office building directly across the street, Sherrie Smith sits behind her desk. She works only a few blocks from the Annapolis wharf, with its rustic “shoppes,” historic landmark buildings, pretty white sailboats, and blue-glass water. Close-shaved cadets in black uniforms walk to town from the nearby United States Naval Academy.
Sherrie is always too busy to see much of the historic scenery outside her office. She’s buried in her e-mail queue, conducting interviews via Skype, and answering the phone. Her job is educating, listening to, and holding the hands of anxious, usually very wealthy, prospective parents from around the globe. She is the program administrator for the Center for Surrogate Parenting (CSP), one of the oldest, most respected surrogacy agencies in the world.
“The biggest misconception about American surrogates?” she clarifies in the beige-on-beige CSP conference room where she spends much of her days. Today, Sherrie wears a deep purple silk suit that sets off her white-blond hair. “That they do it for the money. Having a baby for someone else is as far from easy money as you can get.”
Sherrie Smith has run the East Coast office of the Center for Surrogate Parenting since 1998. She’s now in her sixties. Although she chose not to have kids of her own, she and CSP have helped nearly 1,700 surrogate babies come into this world. CSP’s most famous babies include two sets of twins for Good Morning America host Joan Lunden, and Zachary Jackson Levon Furnish-John, the baby boy born on Christmas Day 2010 for pop rocker Elton John and his husband, David Furnish.
Sherrie’s company was founded in Los Angeles, California, in 1980. Gerry Wile was fourteen. His future wife, Rhonda, only ten. Sherrie’s boss—a Los Angeles lawyer by the name of William Wolf Handel—wrote a third-party reproduction agreement, now called a “surrogacy contract,” as a random, one-off request for a client. Word quickly spread among infertile clients desperate to hire surrogates to have babies. The phone at Handel’s Los Angeles law office started ringing off the hook.
Bill Handel and his staff—all women except the boss—at first struggled to craft a workable set of guidelines in the brave new world of contractual baby making. They knew they’d stumbled upon a promising business opportunity—but a risky one. What if the surrogate changed her mind? many desperate prospective parents asked. A reasonable question, without a clear-cut answer; no legal precedents had been established. So Bill Handel’s female-centric firm came up with an innovative business philosophy: the surrogate herself would have equal standing among the team of doctors, wealthy clients, and lawyers. With a democratic approach, Handel figured that they had a good chance of solving any problems that arose.
“It was impossible to write a contract—or create a company—that was unfair to women when all my employees and partners were women,” Handel explains today. Other women in Handel’s life added their two cents. In addition to his estrogen-rich office, the female clients who hire him, and the surrogates his company hires, insert one wife and two daughters. Women surround Bill Handel twenty-four hours a day.
“I live in a world where the toilet seat is never left up,” Handel laughs.
Lucky for him, the approach proved wildly successful. Almost by accident, the Jewish, Brazilian-born Bill Handel became a pioneer in California surrogacy law. Over the years, his advocacy—plus a plethora of wealthy, high-profile celebrities who publicly embraced surrogacy—helped make California arguably the most surrogacy-friendly environment in the United States. It also made CSP one of the finest, and most expensive, providers of surrogates in the world.
The first surrogate Sherrie Smith encountered had been hired by someone she loved so much, Sherrie would have supported her adoption of a Pet Rock: her sister Fay. After years of negative pregnancy tests and myriad infertility diagnoses, her sister became one of the earliest American women to go public about hiring a paid surrogate. Sherrie’s niece and nephew were both born via surrogate in California, in 1990 and then 1994.
During the years since, Sherrie has learned a great deal about the American surrogates who carry babies for infertile clients from around the world.
The clients are usually older, richer, and better educated than the surrogate mothers they hire. They are also more likely to come from large urban cities like New York, Los Angeles, Paris, and Tokyo, and are far better traveled. Intended parents (IPs) come from an astonishing range of more than fifty countries, from Denmark to Papua New Guinea to Taiwan.
The majority of intended parents are heterosexual couples. Some are infertile due to biological abnormalities. Others face fertility challenges wrought by hysterectomies, car accidents, paralysis, or other medical problems. More and more are gay male couples. (Lesbian couples rarely hire surrogates, given the inexpensive, thoroughly screened sperm on the market and the statistical improbability of two female partners both being infertile.) Increasingly, there are more single women and single men who are consciously and openly choosing to become solo parents. CSP originally worked only with couples, but in 2009 the company changed its guidelines to welcome single parents.
The surrogates are obviously all female, and they’re noticeably younger—the average age is about twenty-eight. The typical profile runs like this: married, Christian, middle-class, with two to three biological children, working a part-time job, living in a small town or suburb rather than a big city, with a degree of college education but usually without a college degree. Women who shop at Walmart and Costco, not Whole Foods and Neiman Marcus.
In the United States, statistics show that surrogates fall into the average household income category of under $60,000. About 15 to 20 percent are military wives.1 Some are single women. Those who are married have husbands who support paid surrogacy; surrogacy is obviously not something you can hide, or withstand with a spouse who is not on board emotionally. They have health insurance. They get paid well—the surrogacy fee paid directly to surrogate mothers who work for CSP runs from $20,000 to $30,000 per pregnancy, tax-free. Surrogates who have already carried babies for clients often command higher fees; as in any position, experience counts. Of the women who serve as surrogates for CSP, roughly 35 percent repeat the experience; in the United States there is no limit to the number of times a surrogate can carry for-profit babies.
CSP is not alone in its strict criterion for surrogates. Ethical surrogacy agencies and lawyers don’t accept two specific categories of potential surrogates. First, they reject women below the poverty level who may be at greater risk for health concerns and coercion, and who probably do not have medical insurance. Second, they reject women who don’t have children. Women who are already mothers have proven they are fertile, and have a more comprehensive grasp of what it will mean to surrender a baby to its legal parents.
Although the money makes a difference, no surrogate signs up just for the money.
“It would be easier to get a job at McDonald’s,” Sherrie insists. “The money doesn’t begin to compensate them for what they do. A surrogate pregnancy means working twenty-four hours a day, seven days a week, without a break, for nine months. Pregnancy is risky; pregnancy taxes your body tremendously. Our surrogates come to us because they love children, they want to help people who cannot have them, and they like the feeling of creating a family for other people.”
Yet undeniably, you’ve got “have” and “have not” differentials at play in the surrogate–intended parent relationship. The surrogates already have what the IPs desperately want—the ability to create babies. What the IPs have is money; they are usually better educated, and far more economically secure. They must be, in order to afford the surrogate’s fee, agency and legal fees, and surrogacy’s medical expenses.
The IPs are consumed by desperation. As a result, their surrogate becomes, at least for nine months, the superwoman in their lives, the embodiment of their most fervent hopes and dreams. Working at McDonald’s or temping as a law firm receptionist can’t compare to being Nicole Kidman and Keith Urban’s savior. Sometimes these economic and fertility dynamics create subtle tensions; many times the enthusiasm of the surrogate and the gratitude of the intended parents smooth over any jagged feelings.
There are some quirks about surrogates. There are very few Jewish surrogates—and almost zero Jewish egg donors. Black surrogates carry babies for white families and vice versa. Surrogates do not pay taxes on the payments from clients, which legally are for pain and suffering incurred, not for carrying a baby. Daughters of surrogates frequently decide to be surrogates themselves; surrogacy can become a family tradition. Gay men, like Puerto Rican pop star Ricky Martin, are the favorite clients of many surrogate moms; one emotional complication is removed from the tricky relationship, because the gay intended parents don’t suffer the understandable jealousy/inferiority issues that can plague infertile intended mothers.
CSP selects only twenty of the four hundred women who apply each month to be surrogates. The most common reasons for rejection? The surrogate lives in a state where commercial surrogacy is not legal. She has health issues such as high blood pressure or obesity. Her motivation is too heavily focused on money. She lives too far away from a level-two neonatal intensive care unit (NICU). She has not yet had a child.
What takes up most of Sherrie’s time is interviewing and managing the clients who retain CSP to oversee the complex surrogacy process. Step one is completion of an online form, available from CSP’s Web site, followed by a phone call with Sherrie. Step two is a half-day interview, conducted in person in Sherrie’s conference room or via Skype (particularly useful for international clients, who account for close to 50 percent of CSP’s parents). The interview includes a forty-five-minute preliminary psychological consultation with one of the independent counselors who work with CSP. Then clients must meet with an attorney familiar with state-by-state surrogacy laws and contracts, as well as international citizenship regulations if the client is from another country.
The first phase in surrogacy has nothing to do with babies, and everything to do with meetings.
During these lengthy consultations, everything about the process—the risks, unknowns, legal paradoxes, and costs—is laid out. Sherrie is a skilled communicator; the most important part of her job is talking and listening. She goes through the minutiae of health insurance clauses that exclude coverage for surrogate pregnancies. She diplomatically broaches whether a surrogate or a client would be amenable to reducing a multiple pregnancy, or terminating a pregnancy if the fetus has birth defects, both important issues to clear up long before they become realities, especially because forcing a surrogate to have an abortion is legally, and ethically, problematic.2
Sherrie Smith wants to see glassy eyes on her prospective clients’ faces, even if they belong to Elton John or Elizabeth Banks.
“The only surprise we want clients to have,” Sherrie makes clear, “is whether they’re having a boy or a girl.”
*   *   *
Far away from Rhonda and Gerry Wile, across the Atlantic Ocean and the Arabian Sea, the young mother named Gauri spent long days caring for her extended family in an enormous Mumbai slum crowded with shacks made of tin walls covered with bright blue plastic sheeting. Like many Indian girls, Gauri was paired as a teenager with a man her parents picked in an arranged marriage. Before she was twenty she had two children. She lived with her husband’s family in one of the large, crowded Mumbai slums which house over 55 percent of the city’s residents.
Her primary responsibilities were caring for her young son and daughter, her husband, and his parents—cooking, cleaning, collecting water from the communal slum pump, shopping daily for food, and hand-washing their laundry. She had never in her life received payment for work. There were few places where an impoverished and uneducated Indian woman with almost no skills and limited literacy could find paid employment. Most of the slum jobs—toiling on a makeshift assembly line in one of the illegal slum factories, driving a rickshaw—were jobs only for men.
This lack of opportunity for herself, and the inherent sexism facing Indian women, did not trouble Gauri. The immediate, and far more serious, problem in Gauri’s life was her husband’s difficulty finding regular work himself. Her husband, a quiet, whip-thin, hard-working Indian man in his early twenties, was unable, like nearly one in three male Indian slum residents, to secure steady employment. On many days there was not a single rupee in their tiny tin shack, and Gauri had to beg a few handfuls of her neighbors’ rice to feed her children.
So when Gauri heard that a Mumbai medical clinic, run by a female doctor—a strange and surprising concept itself—had paid a slum friend thousands of rupees to have a baby for someone else, she was astonished. The friend had gone to live at the clinic during the pregnancy and to recuperate after the birth. She’d spent her days in an apartment with a maid and a cook; she’d been given good food and vitamins and seen a doctor more often than during the rest of her life in total. She had given birth in the private yellow sandstone hospital near the slum, a place only wealthy Indians and Westerners had the money to afford, a six-story building Gauri passed every day but had never seen from the inside. The amount of money for nine months of this “work” was enough that her friend was able to buy a home on the slum outskirts that was large enough for her extended household, transforming herself from a seen-but-not-heard wife, daughter-in-law, and mother into the neighborhood hero.
The friend explained, with a stern look, that she had not had sexual intercourse with the baby’s father. The doctor had put the baby in her body during an operation. It wasn’t her baby. She just grew it. And was paid a huge sum of money when the baby was born. Her friend excitedly explained she even got extra money because the baby had to be delivered via Cesarean section—she made a slash across her lower abdomen with her fist, as if holding a knife.
Gauri thought of all the rice and lentils that money could buy for her children.
The woman said she would make enough with a second surrogate pregnancy to send her daughter to college. Gauri shook her head at the audacity of a slum mother thinking her child could ever attend university, practically unheard of throughout the Mumbai slum world. Just as Gauri did not know any women who earned money by working, she did not know any girls who had gone to college. And anyway, Gauri would be happy just to have enough rupees to feed her son and daughter, without worrying about sending them to university a decade in the future.
All this was legal under Indian law? Her friend assured her it was. And she offered, quietly, to take a very nervous, but also secretly hopeful, Gauri to the clinic if she ever wanted to see it for herself.
*   *   *
Further complicating the dilemmas confronting Rhonda, Gerry, Gauri, and everyone else involved in surrogacy, are the different physical types of surrogacy. Medically and biologically, there are two forms of surrogate conception. Rhonda learned—and explained to Gerry late at night when their grueling shifts coincided—that “traditional surrogacy” is when a surrogate uses her own egg to conceive and carry a baby whom another parent, or parents, will raise. The resulting child is created from the surrogate’s egg, fertilized by sperm from a donor via artificial insemination. The woman carrying the baby is the genetic and biological mother, also known as the “bio mom.” Although he never publicly labeled his path to parenthood as traditional surrogacy and many conception details remain unclear, this is presumably what deceased pop rocker Michael Jackson did through his relationship with nurse Debbie Rowe. Rowe bore two children for Jackson, in 1996 and 1998, and after the couple divorced in 1999, Rowe terminated her parental rights and received $8 million from Jackson.
Traditional surrogacy, like many medical treatments, involves risks and side effects, although at heart they are emotional perils, as Debbie Rowe eventually discovered. Biologically, a traditional surrogate is giving up her own child. Some traditional surrogates suffer grief and doubt during the pregnancy, and long after relinquishing the child—a deep regret and guilt akin to the sorrow felt by mothers who give up babies for adoption. Debbie Rowe twice attempted to regain her parental rights, with mixed results. Perhaps, if a traditional surrogate like Rowe is lucky, this grief and guilt are combined with the sense that she has given another person, or couple, the gift of a child.
What also disturbed Rhonda was the risk that she—known formally as the “intended” mother—might experience inchoate, crippling feelings of insecurity as a parent.
“My most haunting fear was that someone in my family, or a friend or acquaintance, and maybe one day even my child, would decide I was not the ‘real’ mother. Just because of the lack of biological connection,” Rhonda explained as she explored the strange and worrisome idea of traditional surrogacy. “What if I didn’t feel like my baby’s true mother?”
For some intended mothers, as with some percentage of adoptive parents, this pain also lasts a lifetime. It can warp the experience of motherhood. During conception, pregnancy, and the rest of the child’s life—Rhonda learned from blog confessions and magazine articles—some intended mothers suffer an intense and debilitating conviction that they risk losing their child, emotionally or physically. Although in many states traditional surrogates are not legally allowed to change their minds after they’ve signed a surrogacy contract, the intended mother sometimes worries that the bio mother is out there, perhaps merely a town or two away, potentially able to reclaim her child, physically or psychologically.
“Also, any traditional surrogate we hired,” Rhonda clarified, shaking her head, “could have other children, biological half siblings to my child, any time. My child’s surrogate could produce a half sibling for one of my neighbors, someone from work, a family from their school, complete strangers. One day, my child might share a surrogate, siblings, their blood, their genetics with other families. Most moms I know can’t bear to share a babysitter.”
Rhonda thought this was a terrible price to pay for the privilege of being a mother. She had already been through years of dashed hopes and painful, expensive surgeries; she didn’t know how much strength she had left. Rhonda could see—and feel—that traditional surrogacy was haunted by short-term and lifelong risks and penalties. For Rhonda, traditional surrogacy was a far from ideal solution to infertility.
But then she discovered gestational surrogacy (GS), made possible by in vitro fertilization. It made so much better sense to her, it seemed too good to be true. GS differs fundamentally from traditional surrogacy. Embryos are created in a medical lab by combining sperm and an egg unrelated to the surrogate. The resulting embryo, or embryos, can then be implanted in the surrogate’s uterus. The woman carrying the baby has no genetic link to the child. She is providing—some people sardonically call it “renting out”—a healthy uterus on a temporary basis.
“I liked this kind of surrogacy much, much better,” says Rhonda now.
However, not everyone does. This mind-boggling change in conception and gestation shakes the human race’s centuries-old definition of pregnancy and traditional motherhood. Today, a mother of a child, the real mother, the legal mother, does not have to be pregnant or give birth. Sex is not part of conception; nothing even vaguely resembling sexual intercourse is required. One woman, with or without a male partner, can control her destiny by arranging for a baby, her baby, to be created purposefully and intentionally via another woman.
Likewise, one man can buy another woman’s egg and hire a surrogate, to become a parent without a female partner. Surrogacy nullifies the biological imperative for sexual attraction, arousal, and intercourse that have preceded parenthood since the beginning of the human race. The only requirement is intent to be a parent, and, at least at this moment in America, an enormous amount of money to pay a surrogate, a lawyer, and an IVF doctor.
This transmogrification of pregnancy and parenthood diverges fundamentally—and radically—from natural conception. It also differs distinctly from traditional surrogacy, which requires uncomplicated artificial insemination of the egg already inside a woman’s body; not drastically different, in terms of mechanics, from natural conception. Gestational surrogacy also differs profoundly from a child naturally conceived and later adopted by genetically unrelated parents.
For the first time in human history, it has become conceptually and medically possible to intentionally separate and outsource the three fundamental building blocks needed to create human life.
Sperm from one source. An egg from another. A womb wholly separate from both.
This is gestational surrogacy, the new bridge bypassing infertility.
“Wow” was all Gerry could say when Rhonda explained it to him.
For Rhonda and Gerry, GS was an exhilarating concept. From the view of surrogates, intended parents, and lawyers, gestational surrogacy amends many of traditional surrogacy’s inescapable flaws. The critical difference: the surrogate is not biologically related to the baby she gestates. She does not have legal or ethical or genetic claims to parenthood—or any of the guilt that goes along with giving away or selling her baby. Psychologically and practically, the baby is never hers. This makes it far easier for her to be a surrogate, whether she is doing so as an altruistic good deed, or for financial compensation, or a bit of both.
Without a surrogate’s genetic link to the child, there are fewer legal and emotional complications for intended parents like the Wiles, and any resulting children, as well. Separating the egg donor, the sperm donor, and the person who gestates the baby jettisons many of the potentially heartbreaking and complex aspects of assisted baby making.
The baby would always be Rhonda and Gerry’s—long before it was born.
And forever after as well. There would be no “real” mother in the shadows, haunting Rhonda with any claim to the child, now or in the future. Often the gestational surrogate lives in another state or another country. After the birth, if she wants, the surrogate can vanish like chalk erased from a blackboard. For many parents, an advantage of gestational surrogacy is that their children will never meet the woman who gestated them. This may sound coldly self-centered or psychologically immature, but a critical component of any parent-child bond, no matter how the child was conceived or gestated, is the hue of mutual belonging: we are a family, you are my mother, you are my child. No one else’s.
Gestational surrogacy also has the potential, perhaps, to make traditional male-female parenting obsolete, as well as to reduce much of the incentive to create and sustain traditional marriages. The separation of sperm, egg, and uterus, and the lack of reliance upon heterosexual sex to create life, disassembles the biological imperative that has long driven individuals to pair off in order to start a family.
Gestational surrogacy’s only undisputed disadvantage versus traditional surrogacy is that GS requires IVF, increasing its cost and complexity. However, today there are hundreds, if not thousands, of doctors in the United States and other countries who can perform IVF.
It’s the future. And it’s already here.
*   *   *
A few facts about Gauri’s country:
Over 1.2 billion people live there. By the time you’ve read this sentence, it could be 1.3 billion.
India is the world’s largest democracy, with a population nearly four times that of the United States and over twice Europe’s.3
India is as ancient as infertility. One of the world’s earliest civilizations, it can be traced to the Indus Valley between approximately 3100 and 1700 BC, over four thousand years before the United States became the United States.4 Thousands of years before Jesus Christ was born, India maintained one of civilization’s most advanced systems of town planning, burials of the dead, sanitation, and drainage. India produced some of history’s earliest, and greatest, astronomers and mathematicians between AD 100 and 900.
There are twenty-nine states in India. Many have origins dating back 2,600 years. The largest state, Uttar Pradesh, is home to over 165 million people. If Uttar Pradesh were a separate country instead of a state, it would be the world’s fifth most populous nation, smaller only than the United States, Indonesia, China—and of course, India itself.
Large and small are different in India. There are fifty Indian cities with populations greater than Dallas, Texas.5 An isolated rural outpost in India—for instance, one like Hubli, situated between Mumbai and Bangalore, which as recently as twenty years ago was connected to other parts of the country only by train—has 900,000 residents. More people than San Francisco. Nearly twice the entire population of Wyoming.
A small town, India style.
India has eighteen official languages including Hindi, Marathi, Gujarati, Kannada, Tamil, and Malayalam.6 Approximately 65 percent of the population speaks English, a result of the long reign of the British Raj. However, roughly 45 percent of the country’s population is illiterate, unable to read any language.7
There are dozens of religions practiced in India, from Parsi to Judaism to Jainism. The majority of people, roughly 85 percent, practice Hinduism. The second-largest religion is Islam, with 150 million practicing Muslims; Islam has been present in India since the eighth and ninth centuries AD8 and today India has the world’s third-largest community of Muslims. Buddhism originated in India in the sixth century BC—Buddha himself was Indian—and the religion is still practiced there by a small minority. Christianity is also somewhat common at 2.3 percent of the population, again with ancient origins in India dating back to the first century AD.9
By most measures, India is a diverse, loosely knit democracy of multifarious people, languages, and religions, all coexisting, albeit at times uneasily.
An exception to India’s societal tolerance is the country’s 3,500-year-old caste stratification. This ancient system of graded inequality was based on one’s birth family. For much of India’s history, it was impossible to change castes.
Male Brahmins, or the priest caste, ruled at the top of the human hierarchy of castes or “varnas.” The Brahmin outlook placed women at the bottom of all hierarchies. Yet ironically, the term Brahmin originated with Lord Brahma and Goddess Brahmani. Millions of female goddesses from the ancient Vedic religion of early Hinduism are still worshipped throughout India today.
Until the 1950s, despite the abundance of female deities, only male Brahmins were granted access to political power, property ownership, wealth accumulation, and education. Only men had access to medical and scientific knowledge, including yogic and ayurvedic teachings. For centuries, only Brahmin men could practice sun salutations, read books, own property, and make laws.
The Kshatriya, or warriors and landowners, came next below the Brahmins. The Vaishya, or merchants, ranked below the Kshatriya. They were followed by Shudra, or servants. At the very bottom—not even technically on the varna hierarchy—were the Dalits, or Untouchables, Gauri’s caste.
Untouchables like Gauri’s ancestors were historically responsible for disposal of human waste, sweeping, cleaning, and removal of dead animals. They were not allowed to touch members of other castes—elaborate purification ceremonies had to be performed if contact occurred. Untouchables, or Dalits, were not supposed to make eye contact with or even look at Brahmins.
Although Dalits practiced the Hindu religion, they were banned from their own Hindu temples. They were prohibited from drinking from common wells or eating where non-Dalits ate. Their children were barred from schools. All Dalits were forbidden to share clothing, utensils, or transportation with other Indians.
Untouchables were required to carry small terra-cotta pots to collect their spit, so their saliva would not pollute the ground. They had to wear brooms attached to their backsides to sweep away their footprints. Wherever they went, Untouchables had to announce their impending arrival via small tinkling bells or a prescribed chanted warning. In all practices, Dalits were treated worse than wild dogs; dogs, after all, were permitted to drink from human wells and to walk without cleaning up after themselves.
The Indian constitution officially outlawed the caste system in 1950. However, much of the informal societal preferences, privileges, and prejudices remain, especially when it comes to education, job opportunities, and intermarriage between castes. The majority of residents of India’s infamous slums are Untouchables. Dharavi—arguably Mumbai’s most examined slum as the focus of a case study by Harvard Business School and the movie Slumdog Millionaire—has one million residents living in a space two-thirds the size of New York City’s Central Park. Yet the people of Dharavi are remarkably skilled and industrious, producing nearly $1 billion of annual income through makeshift garment and leather-goods factories.10
The Indian government is the largest employer in the world. The Indian Ministry of Railways alone employs 1.5 million people, nearly three times the entire population of Washington, D.C.11 After decades of bureaucratic restrictions, economic stagnation, and widespread corruption, starting in 1991 the Indian government adopted an economic policy of liberalization, privatization, and globalization.
As a result, India’s economy today is emerging, with some bumps along the way, as one of the fastest growing in the world.
One of India’s most robust nascent industries is gestational surrogacy, legal since 2002. There are over five hundred surrogacy clinics in India. India’s surrogacy industry is thriving because of the country’s world-class private hospitals, abundance of English-speaking doctors, plethora of poor but healthy women of childbearing ages, and government regulations that promote surrogacy. A World Bank report projects that India’s commercial surrogacy industry will reach $2.5 billion by 2020. India has become the largest provider of gestational surrogates to the Western world’s infertile couples, outside of the United States. Ironic for a country that already suffers from too many children born every day.
India is full of similar contradictions. Indira Gandhi, prime minister between 1966 and 1984, is recognized as one of the most powerful female leaders of the twentieth century. Indian religious iconography is rampant with female deities such as Lakshmi, the goddess of wealth, and Bhavani, the bestower of life. Yet women’s status overall in India is woeful.
Roughly 50 percent of India’s women are illiterate. India is estimated to have the lowest average age of marriage in the world. Fifteen percent of India’s poorest girls are married at or below age ten. Female genocide of fetuses and infant girls is rampant, with estimates of 15 percent of females in some states being killed before birth or within the first few weeks of life.
From 2001 to 2011 in the state of Maharashtra, which includes India’s largest city, Mumbai, only 888 girls were born for every one thousand boys.12 Despite population growth rates of 20 percent, there were only 914 girls for every one thousand boys under the age of six in India overall in 2011, according to Indian census figures. Due to abortions and infant suffocations, today’s ratio is the highest gender imbalance since the country won independence in 1947.
“There are entire villages with no girls under [age] five,” said Rohini Prabha Pande, an independent demographer who analyzes gender issues in India.13
In India, being a woman means belonging to a separate caste all its own.
Strikingly absent from India’s entrenched prejudices, contradictions, inventions, accomplishments, spiritual teachings, and astronomically high population figures is the most breathtaking number in humanity’s comprehension: the concept of zero.14 Despite inventing the binary system—the basis of modern mathematics—the country’s ancient, brilliant mathematicians, scientists, and astronomers failed to grasp, or utilize, the powerful idea of nothing.
Zero? It doesn’t exist in India.
Which may explain why the idea of zero children is not comprehensible in India, either.
*   *   *
Web sites and travel books promoting India usually tout the Taj Mahal temple, the elephant rides in Jaipur, the beautiful shrines, the delicious spicy foods, and the spiritual and religious wonders of a country with 330 million deities.
A fact that doesn’t usually make the tourism brochures: India has an outstanding health-care system, for those who can afford to pay for medical care. The wealthiest Indians have access to private treatments, operations, and hospitalizations that rival any country in the world. Particularly in large urban areas like Mumbai, where over 35 percent of the population lives, there are top-notch private hospitals and treatment centers, as well as several good government hospitals.
However, the weakness in India’s health-care system—and it is a grave and fatal flaw—is that there are not enough doctors or medical facilities to serve the vast and impoverished Indian population. Not nearly enough. As a result, many of Indian’s poorest citizens get little to no health care over the course of their entire lives. As a Band-Aid solution, all 700,000 of India’s doctors are required to spend one year practicing medicine in a poor, rural area, where the medical infrastructure, particularly for women, is weakest.
Indian surrogates for wealthy international clients, though, enjoy far more generous health benefits than many pregnant women in the United States. As standard preventive care, Indian surrogacy clinics provide extensive prenatal testing and solicitous support. Pregnant surrogates often move into the clinics for much of the pregnancy to avoid the stress and debilitation of cooking, cleaning, shopping, or working. If the surrogate suddenly goes into preterm labor or needs emergency medical care, she is close to medical staff and world-class hospitals. The surrogates remain in the hospital for several days following delivery, and often recuperate at the clinic for an additional week or longer.
In the United States, the average hospital stay for a woman who has just given birth is 1.9 days.15
*   *   *
Back at the Center for Surrogate Parenting, if, after Sherrie’s marathon interviews, an infertile couple (or individual) decides to proceed, they next sign three separate retainers and cough up three different financial deposits. One is for CSP. The next contract is between the client and a separate psychological counseling agency, required by CSP. Unlike many agencies, CSP does not have clients browse through an online catalog of surrogate profiles. Instead, CSP’s counseling team reviews key factors like geographic proximity, preferences in terms of race, religion, and age, and health insurance logistics, and then proposes a liaison between like-minded surrogates and intended parents.
The third retainer is for the attorney who will oversee the contract, birth certificate/passport logistics, and parental rights paperwork. A lawyer experienced in surrogacy and adoption is critical to ensure that clients take their baby home from the hospital as their baby. With their names on the birth certificate.
In some states, when a child is born to a surrogate, a court petition must be filed to amend the birth certificate to include both intended parents as the baby’s legal parents (even when they are the genetic parents). Other states allow the intended parents’ names to be listed on the original birth certificate. A few states will grant gay dads two birth certificates, one with each father’s name listed.
Some states, such as Louisiana, Michigan, and New York, outlaw paid surrogacy. These states do not recognize surrogate births or surrogacy contracts. The disparity in state laws can wreak havoc on IPs’ dreams, such as in 2012 when Michigan sheltered a Connecticut gestational surrogate who refused to abort a client’s fetus with severe birth defects. Some jurisdictions, such as Nebraska, New Mexico, and Minnesota, require a formal stepparent adoption of a surrogate baby. Some countries, such as Canada, ban surrogacy outright, which, for the Wiles, meant Rhonda’s family couldn’t help her.
Of course, if you are the citizen of another country coming to the United States to have a baby via surrogate, you need to make sure your homeland will recognize the baby legally as yours, and as a rightful citizen as well.
The country-by-country, state-by-state logistics and laws can bedevil any rational person. Maryland and California, where CSP’s offices are located, are among the states most friendly to surrogate pregnancy. Prebirth orders designating IPs as the unborn child’s legal parents are routine. Such an order puts the IPs’ names on the child’s birth certificate, and terminates any rights of the gestational carrier. California, where the Center for Surrogate Parenting was founded, is the state that pioneered intent to become a parent as the decisive factor in parental legality—not biological connection. In certain cases, California does not require a mother’s name on a birth certificate at all.
At the other end of the spectrum, states such as Virginia require extensive home study of the intended parents, before the issue of a prebirth order. Washington, D.C., sandwiched between Virginia and Maryland, each with different laws, bars all forms of surrogacy. And even in Maryland, traditional commercial surrogacy, in which the surrogate mother has a genetic link to the child she carries, can be interpreted as a violation of Maryland’s anti-baby-selling law.16 Only gestational surrogacy is allowed when payment is involved.
When CSP began, most surrogacies were traditional—not gestational—with the surrogate providing the egg herself. Now, given widespread access to IVF, almost all of the hundred-plus babies CSP helps create each year are borne by gestational surrogates who have no genetic link to the fetus.
“Most surrogates don’t want the biological connection,” says Sherrie Smith. “Lawyers don’t either.”
Thus the second leg in gestational surrogacy is all about contracts, signatures, and money.
Then, finally, the process turns to baby making. Compared to the meetings, the lawyers, the detailed contracts, and the decoding of state regulations, the medical procedures are relatively simple. For each couple, the process is different. Some use their own egg and sperm. Some need eggs, others need sperm. The fertilization takes place in a petri dish, and the resulting embryo or embryos are implanted in the chosen surrogate.
CSP stays extremely involved, like a case manager or general contractor on a very complex and expensive custom-home construction job. Whether the clients are actors Sarah Jessica Parker and Matthew Broderick, who had twin girls via surrogate in 2009 after six years of trying to have a second baby following the natural conception of their son, James Wilkie, or anonymous private citizens, the process remains the same from CSP’s view. Every baby is precious. Every surrogate is assigned a dedicated liaison. The intended parents get their own personal Web site that tracks all medical results, along with a timeline, and other information related to their surrogate’s pregnancy. Helping gestational surrogates and intended parents make a baby is client-centric craftsmanship, not a high-volume mass market business. CSP is there for every milestone.
It is not as if the clients—whether they are celebrities or your next-door neighbors—pay a huge sum so that poof! nine months later they may magically walk out of a hospital with a baby. The surrogate calls her IPs when she takes that first pregnancy test (often she asks CSP or the fertility doctor to call if the result comes back negative). The intended parents talk or Skype with the surrogate about once a week, discussing medical updates, doctor’s appointments, and the pregnancy overall. The intended parents and the surrogate arrange regular face-to-face meetings.
All parties, including the surrogate’s husband, are usually in the hospital delivery room (CSP does not sanction home births or midwife births). And the parents are asked by CSP not to leave the area with the baby or babies until the surrogate leaves the hospital. No one wants the surrogate to feel like wham-bam, thank you, ma’am, we’ve got our baby and we’re gone. The new parents are encouraged to visit her at her home, if she wants, to show her family the baby, before returning to their home.
“We don’t want the surrogate, the parents, or the children to look back and feel used or disappointed by overenthusiastic promises made during the pregnancy,” Smith explains.
This meticulous, communication-intensive process makes for a very personal, private, and collaborative pregnancy and birth experience. For celebrities like Sarah Jessica Parker, Sofia Vergara, and Ricky Martin, this discretion is obviously useful. Their surrogates, unfortunately, were stalked and targeted by the media. As a result, in support group meetings run by CSP counselors, surrogates are never allowed to use their intended parents’ names.
But respect means just as much to everyday parents. Pregnancy and parenting are confidential, personal life experiences. CSP tries to keep the experience emotionally safe for everyone involved.
The third trimester of a surrogate pregnancy—like any pregnancy—is all about prepping for the baby’s arrival. Most important are the legal issues relating to parental custody; the client’s lawyers get very busy in the last three months. Intended parents are encouraged to get a hotel room with a kitchenette within a few miles of the hospital, and to book a minimum ten-day stay. They are issued hospital name tags to get them admission to the maternity ward and delivery room. CSP cautions them to be prepared for premature delivery, unexpected hospital costs, time lost at work—exactly as if they were the gestational parents.
Clients who live close to their surrogate’s hospital are warned that they are most likely to miss their babies’ birth. Because they are nearby, many underestimate the time it takes to get to the hospital and check in. Despite the years, dollars, and heartbreak it took them to have this baby, local IPs are, refreshingly, just like other expectant parents who live a little too close to their hospital.
*   *   *
Even Gauri, despite her meager education, knew the name Gandhi. And not just because the Mahatma’s spectacled face smiled at her on paper rupee bills, when Gauri was lucky enough to have a few rupees. Under Gandhi and his nonviolent compatriot Nehru, India won its independence, or “home rule,” from Britain in 1947, after two centuries of British colonialism and dominance.
Or so history books report.
The reality is that half the population won independence in 1947.
Not Gauri’s half. The male half of India won independence in 1947. At least, as much freedom as one can experience in a vastly overpopulated, impoverished country bound by centuries of tradition and caste dictates.
For most Indian women, life did not change significantly after 1947. Women’s oppressors—Indian men, British men, and centuries-old mandates from both cultures—dominated nearly every aspect of women’s daily lives.
In 1947, many people around the world believed women were inferior to men, or at the very least, quite different from men. Not just in India.
Halfway through the twentieth century, many countries were struggling, to varying degrees, with granting women rights equal to men. American women had been voting for fewer than three decades. Women had been graduating from the two oldest universities in the world—Oxford and Cambridge—for a mere twenty-seven years. Chinese girls were still having their toes and foot arches broken for the crippling yet desirable “lotus feet,” which prevented them from running—or even walking—away from men and their families.
However, the reality even now, despite advances in women’s equality, is that over 500 million Indian women and girls today, including Gauri, lead bleak daily lives without the right to pick whom they marry, to learn to read, to work for pay, to inherit money, or to own property. Additionally, because laws designed to protect women are rarely enforced, Indian women do not have the right to prosecute a rapist, to divorce a physically abusive husband, or to seek justice if abducted and forced into prostitution.
India has allowed certain women—to be fair, several thousand—to benefit from the same educational and legal opportunities offered Indian men. Many of us in North America have female Indian professors, female Indian doctors, Indian college classmates, and Indian colleagues who buck the stereotype of illiterate Indian women with scant education and dismal earning potential. A country of over 500 million women will, invariably, produce a few strikingly tough, brilliant, stereotype-defiant women with the luck, enlightened fathers, and intelligence required to burst through India’s glass crawl space.
The most obvious is India’s powerful, iconic leader, Nehru’s daughter Indira Gandhi. (Despite their shared last name, neither Indira Gandhi, her husband, nor any of their descendants are related to the famous male Gandhi; Indira’s maiden name was Nehru.) Indira Gandhi ruled India for fifteen nonconsecutive years during the 1960s, 1970s, and 1980s, until her assassination in 1984.
Indira Gandhi has been India’s only female prime minister. Let’s just say, not everyone loved her. She was considered excessively authoritarian and corrupt by her enemies. She implemented India’s nuclear power program in 1967. She instituted cruel and discriminatory actions against India’s poorest citizens under cover of her 1975 to 1977 “state of emergency,” bulldozing slums that provided shelter to millions of India’s lowest-caste citizens.
In 1984, she mobilized the Indian military against the Sikh population in the Punjab region, entering and destroying the Golden Temple of Amritsar, a sacred Sikh sanctuary that extremists were using for shelter. Her aggression triggered her assassination later that year. Her own trusted bodyguards, Beant Singh and Satwant Singh, fired over thirty shots into Indira Gandhi’s body on a bright, lovely autumn morning on the grounds of the prime minister’s residence at One Safdarjung Road in New Delhi, until she was dead two or three times over.
But despite these failings, Indira Gandhi was, without dispute, a powerful, undeniably successful Indian woman.
There are many others.
Dr. Muthulakshmi Reddy’s life spanned two very different Indian centuries, from 1886 to 1968. She was the first—and one of the most respected—female Indian doctors. She was the first female student to be admitted into an all-male college; the first woman surgeon in the Government Maternity and Ophthalmic Hospital; the first woman legislator in British India; the first chairperson of the State Social Welfare Advisory.
Hands down, a great woman and leader.
Another name that springs to mind is Agnes Gonxha Bojaxhiu. Although she was born in Skopje, Macedonia, her Catholic ministry was based in Calcutta. She was an Indian citizen. She became known throughout India, and the world, as Mother Teresa.
Five of the top one hundred richest women in the world are Indian. Including billionaires Savitri Jindal of Jindal Steel and Anu Aga of Thermax energy. Biocon’s Kiran Mazumdar-Shaw is ranked seventy-fifth on Forbes list of the world’s richest women, with a net worth of $900 million.
And let’s not forget the dozens of famous female Bollywood actresses, including Katrina Kaif, Juhl Chawla, Shilpa Shetty, Kashmira Shah, Madhuri Dixit, Kareena Kapoor, Tanuja, Rekha, and Kajol, to name a few.
However, here’s the truth about India, despite these exceptions: the best you can say is that the country neglects a valuable resource, its average female citizens. The ones not destined to lead a country, become a beautiful Bollywood star, or get into Stanford Medical School.
Another, perhaps more blunt, characterization is that India conducts war against most of its women throughout their lives: through gender-based abortions, female infanticide, child labor, child prostitution, forced marriage, slavery, dowry murders, gang rapes, and wife burning.
Can a country judge itself only by its most spectacular citizens? What about people born without any advantage or privilege? One of the most astonishing truths about this remarkably astonishing, ancient, and prescient country is that much of India’s customs and traditions treat girls as if they simply do not count as human beings.
In India, as in most societies, women conceive, gestate, nurse, feed, discipline, nag, nurture, and raise their country’s children. On a daily basis, women promulgate the country’s future in ways inconceivable to most men. India would not exist without its women. Paradoxically, the most ancient and most popular Indian deity is female: the Great Mother goddess Devi, whose cult dates back more than three thousand years, and whose powers include intense feminine sexuality, warfare and weaponry, and death.17
Yet nearly every family in India values men and boys more than girls.
Despite Indira Gandhi, Mother Teresa, and the many brilliant Indian women many of us know personally, most girls eat last in Indian families. Historically, girls are educated last, in inferior schools, if they are educated at all. Girls are raised to be servants; millions work as unpaid cooks, housekeepers, and nursemaids every day of their lives.
Every day in India, seven thousand girls are killed before they are born, according to research presented by Walter Astrada in his 2009 Alexia Foundation documentary, Undesired.18 Conducting an ultrasound to determine a fetus’s gender, and selective abortion based on gender, are both illegal—for parents and doctors—in India. Ditto for cheap fetal DNA blood tests that determine a baby’s sex, with more than 95 percent accuracy, at only seven weeks of pregnancy. Yet widespread bribery and cultural bias against girls makes gender-based ultrasound and abortion of female fetuses almost routine among middle- and upper-middle-class Indian families.
Impoverished families cannot afford the technology of ultrasound, blood tests, or abortion. Instead, girls born into poverty are frequently “put to sleep”—smothered by their mothers in infancy.19 The Hindustan Times and the UK’s Telegraph have both also reported stories of Indian doctors who perform sex-change operations on infant girls, resulting in neutered genitalia, apparently convincing enough to persuade relatives, and to justify the mutilation.
Poor girls and women like Gauri can be bought and sold in India. Forced by their fathers to marry when they do not want to. Discarded by their husband’s families if they do not serve obediently or produce male offspring. The New York Times’s Nicholas Kristof estimates that India has more modern female slaves, imprisoned in brothels as young girls, than any other country on earth.20 Rigid estate laws dictate that only the eldest boy may inherit unless there is a legal will explicitly designating female heirs. If a man dies without a will, his female children have no recourse—although there is a rumor whispered around Mumbai about a female heir to millions who voluntarily underwent a genital sex change operation as an adult in order to legally inherit her family’s estate.
Without sons or husbands, women become largely invisible and disposable. The practices of abandoning, beating, burning, and divorcing women who do not produce sons is tolerated by much of India’s culture and government, despite official laws against these practices. As recently as 1987, widows committed sati, or self-immolation on their husbands’ funeral pyres, despite the practice having been outlawed in 1829.21 Bride burnings in retaliation for insufficient dowries were reported as recently as 2010.
Much of the prejudice against women and girls in India is based upon the outdated but stubborn societal construct that boys grow up to earn and inherit money, while girls devour resources with no return on investment. Girls are expensive to raise, the logic goes. They cannot legally inherit family wealth, and they cost families great sums of dowry money when they become marriageable. Men, hypothetically at least, are obligated to support their parents, wives, and children financially; this agreement is not always honored, particularly if their wives do not produce male children.
When a daughter marries, her primary obligation is to serve her husband’s family. Like Gauri, women are obligated to spend their lives cooking, cleaning, bearing and raising children, caring for aging in-laws. Their natural families come second, if at all, making grown daughters nearly useless to their families of origin.
It seems to make scant difference that this cultural imperative was long ago made irrelevant by education, birth control, changes to inheritance laws, and employment opportunities for women as India’s economy has become increasingly globalized.
Today’s reality is that in most cases, it is far cheaper to educate a girl than to pay a dowry. The Indian government offers financial incentives to educate girls. Yet the practice of devaluing women and the work they do for their families continues.
An estimated 20 million female Indian infants were killed before birth, or born healthy but killed by their parents, from 1985 to 2005.22 Those girls lucky enough to be born and to survive infancy are regularly abandoned to the streets or to homes for unwanted girls. These girls grow up to be beggars, most commonly, earning roughly one rupee a day. One rupee is equivalent to about two American pennies.
A day.
*   *   *
Today surrogacy is becoming common, increasingly unremarkable, throughout the United States and around the world. Infertile celebrities and famous gay men smile on magazine covers, holding cherubic babies created via U.S. surrogacy agencies. Hope has been granted the ordinary infertile, too.
All because of a breakthrough that occurred on July 25, 1978.
The place was Oldham, England, 208 miles from London. The ancient Anglo-Saxon town of roughly 100,000 people lies in Lancashire. Surrounded by windswept moorland, heath and bracken, the town sits eleven miles from the stadium where the famous Manchester United soccer team plays its home matches today.
Oldham literally means “old town.” Flint arrowheads suggest humans inhabited Oldham as long as ten thousand years ago. More recently, Oldham was a boomtown during the Industrial Revolution of the late 1800s, spinning more cotton than France and Germany combined. But by the 1970s, Oldham was a declining, depressed, boarded-up town without significant industry.
Except for two highly focused, very motivated scientists.
The first was a brilliant gynecological surgeon named Patrick Christopher Steptoe. Dr. Steptoe was quiet and cerebral looking, with black bushy eyebrows and a small, pursed mouth. The expression on his face combined intelligence, concentration, and determination. He perennially seemed to gaze off into the distance, to a point beyond the horizon. People looking at him got the sense that his mind always grappled with hard-to-solve problems.
His partner was Professor Robert Geoffrey Edwards, a visionary British researcher specializing in the study of human embryos, tiny little organisms no bigger than a freckle. Bob Edwards was more relaxed, an outgoing, rugged outdoorsman with bottle-glass spectacles and a kindly face. He had a wide, easy smile and a hearty laugh.
Conception the old-fashioned way involves one man and one woman. Various simultaneously erotic and precise biological factors must take place inside the woman’s body at the right time, under the right circumstances, in the correct order. The health of both sperm and egg, as well as the timing of their release and meeting, must be impeccable for a baby to be created.
By contrast, in Oldham in the 1970s, these two men were obsessed by what went wrong inside a woman’s body during conception. They sought to correct nature’s mistakes through a science fiction recipe for procreation. Steptoe and Edwards were working toward a single goal: to replicate human reproduction by extracting a woman’s egg, fertilizing it with sperm in a test tube, and implanting the resulting embryo back in the woman’s uterus to create a baby. They called the process, as yet unproven, in vitro fertilization. They were determined to create pregnancies in a glass tube for couples who could not conceive by themselves the old-fashioned way.
Why did they want to do such a thing? Were they mad scientists? Misguided do-gooders with a God complex? Biotech businessmen looking to create a multibillion-dollar industry?
Not exactly.
The two men shared a revolutionary, humanitarian ideal: that everyone who wanted a baby should have a baby. They did not believe that nature, or human biological quirks in men’s or women’s bodies, should discriminate against people who craved babies. Instead, they fervently agreed that the inability to have babies should be treated as a disease that could be cured. That doctors could, and should, use their knowledge and skills to help fix nature’s reproductive mistakes.
“Eye hoop they all have babies!” Professor Edwards told Washington Post reporter Liza Mundy in 2005 in his Yorkshire brogue. “What coood be better than a baby?”
*   *   *
Although surrogacy and ART represent recent, revolutionary, extremely expensive medical developments, human eggs have been fertilized outside a woman’s body since the 1940s. An American doctor, John Rock, and his research assistant Miriam Friedman Menkin, first successfully fertilized eggs with sperm in a test tube in a lab in Boston in 1944—the very year the American Society for Reproductive Medicine was founded by a tiny group of fertility experts in Chicago.
Dr. John Rock was a Harvard-educated ob-gyn, father of five, and eventual grandfather of nineteen. He married the granddaughter of Civil War hero William Tecumseh Sherman, Anna “Nan” Thorndike, in 1924. He then went on to get credit for inventing the birth control pill in 1960 despite being a devout Roman Catholic. Now that’s a fact the church doesn’t publicize—that a Catholic doctor oversaw the clinical trials that resulted in Enovid, the first FDA-approved birth control pill. Rock’s brainy assistant, Menkin, was a Cornell-educated divorcée. Together, they were the first medical team to fertilize live ova with live sperm outside the human body.
However, Rock and Menkin never attempted to transplant the fertilized eggs back inside a woman’s uterus. They let all their fertilized embryos die in the lab. Test tube fertilization was accomplishment enough.
For John and Miriam, at least.
But not for infertile women desperate for babies.
In the 1940s and 1950s, after the results of his experiments were published, women deluged Dr. Rock with written inquiries and desperate phone calls about how their eggs could be fertilized. The next phase of IVF research proved both exciting and controversial. During the 1960s and 1970s, many doctors and scientists attempted to transplant fertilized embryos back into women’s bodies. Infertile women urgently wanted and needed medical help.
Yet federal regulations restricting IVF experimentation curbed the race to create the first test tube baby. In 1973, a New York doctor at Columbia-Presbyterian Hospital attempted IVF. His boss stopped the experiment, removed the fertilizing egg from an incubator, and exposed the embryo to room temperature. This halted the cell division necessary for maturation.
The IVF movement was at a crossroads, in the United States, at least. The technology was almost there. American society wasn’t.
*   *   *
In 1962, back across the pond in England, Professor Edwards and Dr. Steptoe continued experimenting with in vitro fertilization, focusing on the critical step of getting a fertilized embryo back into a woman’s uterus. Steptoe had developed an innovation in abdominal surgery called laparoscopy. The procedure allowed the easy retrieval of mature human eggs—a critical advancement in the science of IVF.
Doctors Steptoe and Edwards spent nearly two decades experimenting with the multiple steps of IVF. They completed over 750 experiments. They attempted over eighty embryo transplants with anesthetized women desperate for babies naked on their examining table.
Each and every transplant failed to produce a pregnancy.
Then came the very first Big Fat Positive.
In 1977, a thirty-year-old British woman, Lesley Brown, and her husband, a truck driver named John she had met when she was only sixteen, had been trying for nine years to conceive a baby. Lesley Brown produced healthy eggs, but her fallopian tubes were blocked by disease. The scarring prevented her eggs from making it to her uterus to meet up with John’s sperm during ovulation. For thousands of years, women like Lesley Brown spent their entire fertility life span trying to conceive a child, without a single pregnancy, and without ever understanding why their bodies could not make a baby.
Steptoe and Edwards were still experimenting. Critics of their research predicted their treatment would lead to terrible abnormalities and birth defects. Every one of the doctors’ attempts at in vitro had failed.
But Lesley Brown was willing to try anything in order to get pregnant. She agreed to let the doctors try to fertilize one of her eggs, using her husband’s sperm, in a test tube outside her body.
One cold November day in 1977, Steptoe successfully extracted a single newly ovulated egg from one very anesthetized Lesley Brown. In a room nearby, John Brown provided fresh semen—20 million sperm, give or take a few. Edwards doused the single mature egg extracted from Lesley’s ovaries with her husband’s fresh sperm. The resulting fertilized embryo grew in a petri dish for two days, dividing and subdividing. Then, once the fertilized embryo had matured and stabilized, Edwards transferred it back into Lesley’s uterus. In December, Lesley Brown was officially pregnant. The resulting baby—Louise Joy Brown—was born in 1978, shattering centuries of infertility.
For good.
A breakthrough had been achieved in the old town of Oldham. The first successful in vitro fertilization was quickly replicated around the globe. Five thousand miles away in Calcutta, India, physician Subash Mukhopadyay had been performing experiments on his own with primitive instruments and a household refrigerator. His tinkering resulted in a test tube baby, later named “Durga” (alias Kanupriya Agarwal), who was born on October 3, 1978, three months after Baby Brown’s arrival.23
Within four years, Louise Brown had a younger sister, Natalie, also born via IVF under Steptoe and Edwards’s tutelage. Natalie Brown was the world’s fortieth test tube baby; soon after, people stopped counting. The process of retrieving eggs from a woman’s ovaries via laparoscopy became routine in Europe and the United States, requiring ten minutes in an outpatient doctor’s office. Almost every subsequent fertility innovation—the injection of hormones to trigger ovulation, intracytoplasmic sperm injection, gamete intrafallopian transfer, embryo cryopreservation, egg donation, and even gestational surrogates—has built upon Steptoe and Edwards’s bedrock IVF methodology.
Because of Steptoe and Edwards, these days, in vitro fertilization is a procedure that you and I refer to conversationally. Like everyone else on the planet, we throw the internationally known acronym IVF around casually.
As in, “My sister did IVF and now she has twins.”
Or, “My boss didn’t get married until she was forty-two, did IVF once, and now she has a three-year-old.”
Or, “Who cares if that numbnut broke up with you on your thirty-ninth birthday? You can just freeze your eggs and do IVF when you’re fifty.”
However, what Edwards and Steptoe accomplished was anything but blasé. Their focus led to what many believe to be the single most impactful technologic invention affecting women’s reproductive lives and their ability to have babies today. In 2010, in Stockholm, Sweden, their medical audacity won the Nobel Prize.24
Edwards and Steptoe tackled a terrible affliction that ironically was never a big problem for the human race. Not on a macro level. Look around: there are over 7 billion of us, after all.
What made their determination so compelling, compassionate, and unique is that infertility is a problem only for the person who’s got it. Then infertility can become an insurmountable, intensely personal, crushing, soul-sucking, lifelong affliction. Steptoe and Edwards’s 1978 success did not banish infertility—or its heartbreak—from the face of the earth. But what the good doctors created, along with their amazing medical innovations, was hope.
*   *   *
Gerry and Rhonda Wile first traveled to India thirty years after Steptoe and Edwards’s first test tube baby was born. They left from Arizona for Mumbai on Friday, April 4, 2008. Rhonda had never before ventured outside North America. Gerry’s military service had taken him to Europe and the Middle East, but this was his first trip to Asia in civilian clothes. Although they’d been married for eight years, in many ways, this trip resembled the honeymoon the Wiles had never had the time, or the money, to take.
If Gerry and Rhonda Wile had been born in Mumbai, they would never have met, dated, or married. Separation of the sexes and arranged marriage are still commonplace in India. A national poll conducted in 2006 showed that 72 percent of Indian respondents believed that parents—fathers in particular—should have the final say in their children’s choice of marriage partners.25 Although in a curious way, Rhonda’s parents, especially her father, did play a key role in their marriage.
When the Wiles landed at Chhatrapati Shivaji International Airport, Rhonda, in her wrinkled travel clothes, was first struck by the heat and humidity, as powerful as a blast from an oven. And then the smells—of women sweating in silk saris, men in the khaki pants introduced by the British during their long reign, the spices, the diesel exhaust fumes. And the bright colors of the children’s school uniforms, the chocolate eyes of their taxi driver, the colorful billboards lining the road from the airport to their hotel.
Until a few years ago, several of the floors at the international airport were unpaved dirt. Most of the running water is not safe to drink—in the few places that have indoor plumbing. Electricity is scarce as well, and current surges and blackouts, even in hotels, hospitals, and the airports, are common occurrences
Over 20 million people live on the cluster of seven islands collectively known as Mumbai, the world’s most populated metropolis. Mumbai is located on the west coast of the country, and is the capital of Maharashtra, India’s second-largest state. The city’s name was officially changed from Bombay to Mumbai in 1995, reflecting its ancient patron goddess Mumbadevi. But the former name is often still used.
The city sprawls along a deep natural harbor in the Arabian Sea, which long ago attracted the traders who established Mumbai as India’s commercial capital. Once a Portuguese princess’s wedding gift, later a paean to neo-Gothic British architecture and culture, Mumbai today is an enigma of slums, world-class hospitals, film production companies, and expensive skyscrapers clinging to pieces of the globe’s priciest real estate. Like Manhattan and Hong Kong, Mumbai epitomizes a beggar’s dream—and an urban planner’s nightmare.
The sound of Mumbai today, at any hour of any day of the week, is a never-ending cacophony of honks and whistles coming from the cars, bicycles, rickshaws, motorcycles, and motorized carts that clog every road, and most sidewalks, throughout the city. Despite the malarial mosquitoes and less-than-pure water sources, the most dangerous act in Mumbai is simply crossing the street.
Rhonda and Gerry celebrated their eighth wedding anniversary on April 14, 2008, at Lilavati Hospital in the heart of Mumbai.
“There was no more romantic or exciting place in the world, for both of us at that moment, than that hospital in India, eight thousand miles from home, making a baby,” says Gerry now. “It was a miracle, what we were doing together.”
It was also miraculous, in an entirely different way, that two people had to travel so far, and spend so much money, to make a baby together.
The Wiles found the city’s roads and walkways muddy and wet, as they often are leading up to Mumbai’s monsoon rains. The air is hot and humid and polluted much of the year. Packs of small, skinny wild dogs and 2,000-pound humpbacked Brahman cows with long, dark brown horns roam the streets freely, sleeping undisturbed in front of ATMs and gelaterias. Over 55 percent of Mumbai’s people live on dirt floors in makeshift metal shacks in the city’s enormous slums. Most slums have inadequate toilet and washing facilities; on the way to the hospital one day, Gerry and Rhonda saw a child squat and lift her pink ruffled skirt to defecate on a crowded roadside as their taxi whizzed by.
Not the ideal place that anyone, particularly Americans who routinely carry hand sanitizer in our purses, sterilize our vegetables with spray cleaners, and refuse to sit on a public toilet without an untouched, crinkle-free paper seat liner, would envision to have a baby.
“To our surprise,” Rhonda says with a laugh now, in her American kitchen two continents away from Mumbai, “we both felt right at home.”

 
Copyright © 2013 by Leslie Morgan Steiner