For many people coming of age during the 1970s, 1980s and even into the 1990s, our sex education and knowledge of the female body came from two sources: Judy Blume books and the Boston Women’s Health Book Collective’s Our Bodies, Ourselves.
First published commercially in 1973, Our Bodies, Ourselves was — and still remains — a revolutionary source of frank, detailed and accurate information about biologically female reproductive organs developed to empower women through knowledge and to emphasize women taking full ownership of their bodies. By 2016, Our Bodies, Ourselves had been reproduced in 30 languages, with new adaptations underway.
Continuing the tradition of being pioneers in women’s and reproductive health, Our Bodies Ourselves — now also a nonprofit public-interest organization — is shining a light on the complicated legal, ethical and logistical issues surrounding international surrogacy through a website called Surrogacy360.
According to Sally Whelan, the program director of the Our Bodies Ourselves Global Initiative (and a co-founding member of OBOS), Surrogacy360 was created “as a strategic response to one aspect of a wider and growing issue in human reproduction.”
To clarify, international surrogacy involves an arrangement between a gestational mother living in one country and intended parent(s) living in another. For example, it could involve a couple from the United States traveling to India where a local woman is impregnated via IVF and carries and delivers their baby. It is considered domestic surrogacy when the gestational mother and intended parent(s) are located in the same country.
Whelan and her OBOS colleagues noticed two aspects to international surrogacy: the assisted reproductive technologies and social arrangements that make new options for families possible and at the same time, the fact that the women — primarily in the global south — providing their services in third-party reproduction could face health and human rights risks.
This led to one major question that guided Our Bodies Ourselves’ work:
“How can we make use of these enormous benefits of assisted reproductive technologies and arrangements and avoid new forms of health and human rights risks?” Whelan told SheKnows.
Surrogacy360 doesn’t aim to influence users either to opt for or against international surrogacy; rather, it provides it provides people considering surrogacy with accurate, evidence-based information on the risks to those involved in an arrangement.
“In OBOS tradition, one of the most useful things we can do is make sure people considering surrogacy have everything they need to make all informed decisions,” Whelan explained.
The OBOS Global Initiative partners with other research and policy organizations around the world, including in India and Nepal, and are finding increasing international surrogacy arrangements popping up in Mexico, Cambodia and Vietnam.
“Those groups, along with other researchers, have documented a good number of risky practices that are common in international commercial surrogacy arrangements,” Whelan noted.
These include mandated and medically unnecessary C-sections, dorm-style living arrangements for gestational mothers with restricted movements, contracts that many gestational mothers can’t read (severely limiting informed consent) and other health risks associated with multiple births.
At this stage, Surrogacy360 is only focusing on international surrogacy — not domestic surrogacy that occurs within the United States.
Ayesha Chatterjee, program manager of the OBOS Global Initiative, said that there were already a lot of websites focusing on domestic surrogacy.
“We did a comparison between transnational and domestic agencies, and it’s a different ballgame,” she explained. “Just as somebody coming to it as a potential option, there is a huge difference in the kind of information that’s provided.”
For example, based on what they have heard from people considering surrogacy in the United States, Chatterjee said that there seem to be a lot of practices that aren’t replicated in international contexts, including having more contact with gestational mothers, more legal recourse for gestational mothers and more medical follow-up postpartum.
“A lot of that is just not an option internationally,” she said. “Domestic agencies build up the relationship with the surrogate. International agencies minimize the contact and relationship with the surrogate.”
In order to create Surrogacy360 and highlight some of these ethical quandaries and health risks, OBOS Global Initiative tapped their long-standing network of colleagues who had been working in the field of assisted reproduction for a long time and doing important work to document risks, Whelan said.
Chatterjee added that all the information on the site is written by professionals and peer-reviewed.
“Some of these things [like international surrogacy] can seem like very niche issues — they don’t affect a lot of people, pop up in media sporadically, and are under the public radar,” Whelan explained.
“It is hard to connect the dots between international surrogacy and other issues in assisted reproduction, but the connections are there and the new website Surrogacy360 helps to make them. We want to encourage new options for creating families, but at the same time make sure people are getting the information they need about all the stakeholders in these new types of arrangements.”