Does India need a new independence struggle? The fight this time would not be against British colonialism, but rather against the UK’s approach to regulating reproductive medicine. At a time when India is considering a sort of matchmaking service for Western couples seeking to hire Indian surrogate mothers, the UK government has announced the abolition of two leading medical regulatory agencies.
Meanwhile, as these countries move further down the road to free markets in reproductive medicine, France is debating all of its bioethics laws — and continuing to stand up for a different model, focused on social justice and the protection of vulnerable women. There is an alternative simply to letting the market decide, the French assembly says.
At some point, many countries are likely to find themselves embroiled in similar debates and controversies over reproductive rights and obligations.
So it is necessary to clarify what is at stake in how we regulate — or deregulate — in vitro fertilization (IVF), egg sales and surrogacy.
It may come as a surprise to US observers, in particular, that the UK approach could be considered “free market.” After all, the UK forbids outright payment for eggs, whereas in the US, a highly differentiated market has grown up around “consumer demand.” The UK also has a national regulatory agency for IVF, whereas the US has a patchwork of state regulations — or a lack thereof.
However, the UK’s Human Fertilization and Embryology Authority (HFEA) might not be around for much longer. British Prime Minister David Cameron’s government announced in July last year that it intended to abolish the HFEA by 2014, along with the Human Tissue Authority, which deals with non-reproductive tissues. Already, the HFEA appears to be attempting to preempt the government by softening its regulatory touch.
Last month, the HFEA finished a consultation on increasing the level of “expenses” payable for eggs used in IVF. European law forbids outright payment for eggs, but the authority suggests that increasing “expenses” considerably would not constitute an impermissible inducement. The HFEA is merely “removing disincentives,” not “creating incentives.” You could be forgiven for missing the difference.
Proponents of the Assisted Reproductive Technologies Regulation Bill 2010, now before the Indian parliament, employ a similar rhetorical twist. They say that the bill actually protects surrogate mothers — for example, by limiting the number of pregnancies they can undergo. However, the law would make surrogacy contracts legally binding, requiring the mother to give up the baby even if she changes her mind.
Opponents say that the agencies making the arrangements will be the biggest winners — that the huge profits they reap will dwarf the fees paid by foreign couples to the women bearing their children. As N.B. Sarojini and Aastha Sharma wrote in the Indian Journal of Medical Ethics, “The Bill actively promotes medical tourism in India for reproductive purposes.”
France, like most European countries, has a problem with reproductive tourism: a yearly shortage of about 700 egg donors sends some couples over the Pyrenees to Spain, where private IVF clinics pay providers more in “expenses” than the UK allows. Even so, the draft bill continues to prohibit payment for eggs.