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Jennifer Lahl on Breeders: A Subclass of Women?
Jennifer Lahl, Director and Executive Producer of the new documentary film Breeders: A Subclass of Women? about the experience of women and surrogacy, is president and founder of the Center for Bioethics and Culture in Pleasant Hill, California. The Center, which campaigns “for a human future,” seeks to educate the public about issues connected with “taking, making, and faking life,” such as euthanasia, assisted suicide, fetal genetic testing, gamete donation, surrogacy, and cloning. The Center confers its annual Paul Ramsey Award, named after the distinguished Princeton ethicist, on individuals “who have demonstrated exemplary achievement in the field of bioethics by equipping our society to face the challenges of the twenty-first century, defending the dignity of humankind, and embracing ethical biotechnology for the human good.” Previous recipients have included Leon Kass, Gilbert Meilaender, and Edmund Pellegrino. The 2014 recipient was Dr. Daniel Sulmasy.
Ms. Lahl, whose Breeders completes a trilogy of documentary films on artificial reproductive technologies, has been a pediatric nurse and hospital administrator for 25 years. She is also a member of the editorial board of Ethics & Medicine. Her previous films, Eggsploitation (2010) and Anonymous Father’s Day (2012), considered ethical problems for donors and resultant children of sperm and egg donation. Breeders examines the moral issues posed by surrogacy, a growing phenomenon with the rise in infertility and the emergent same-sex-marriage movement’s quest for parenthood. Ms. Lahl discussed her film and surrogacy with John Grondelski.
The last time surrogacy was in the mainstream media, Bill and Elizabeth Stern were fighting with Mary Beth Whitehead in a New Jersey court over “Baby M.” But “Baby M” is now 28 years old. Why your interest in surrogacy now? What led you to make the film Breeders?
I’ve been writing, speaking, and making documentary films on third-party reproduction for a decade, so my interest in surrogacy is not a matter of now. Breeders is our third film in a series on assisted reproductive technologies (ART). Our first film, Eggsploitation, looks at the phenomenon of egg “donation” and the risks to young women who decide to sell their eggs. Then we produced Anonymous Father’s Day to tell the stories of people born via anonymous sperm donation who are challenging the belief that the kids are all right. Now Breeders shows the side of surrogacy the industry doesn’t want shown.
Some critics have attacked you for drawing one-sided conclusions: For the few cases where surrogacy hits the rocks, there are other cases of happy families with babies, for the few cases where ova donation encounters some side effects, there are many more where donors enable infertile women to have children. How would you respond to critics who claim you are engaged in biased scare tactics?
Two responses. First, the genre of documentary filmmaking, by definition, involves documenting a story, unlike journalism, which has as a goal reporting all sides of a story. So we choose to document the stories of those who have been harmed and who regret their decision, and who want to inform others in order to prevent others from being harmed. Second, no one seems to question why the fertility industry doesn’t highlight the risks and the failures of what they do instead of showcasing only the successes. If you visit any fertility website, surrogacy broker’s website, or egg donor recruiting page, all you will see are happy, smiling people with cute healthy babies. Our work is focused on promoting fully informed conversation, which requires us to look squarely at the risk and harms to all the parties involved: donors, sellers, industry stakeholders, and, of course, the children.
Some might ask why you chose to address surrogate motherhood. Abortion, after all, occurs more than a million times a year. Surrogacy hardly attains that scale. Surrogacy perhaps raises some challenging ethical issues but—honestly—how many people does it really affect?
I resist the idea that the scope of a harm should be a primary criterion for involvement in addressing a harm. Having said that, a solid case can be made that this is a much larger issue than many realize. In the U.S. alone, the infertility industry is a multi-billion dollar industry that affects many, many people. But it’s not just the U.S. alone; surrogacy is truly global. A woman in Thailand may carry an embryo created with sperm from Northern Europe and an egg from Eastern Europe so that a couple in the United States can build their family. Surrogacy is also a growing issue, particularly as more same-sex male couples are marrying and wanting to raise children. Perhaps the better question is: How can we not address surrogacy?
Your film calls the United States the “Wild West” of surrogacy. Perhaps, but isn’t it really a question that, since Roe. v. Wade and its progeny, American public policy has recognized that decisions about reproduction and childbearing are private and personal matters the government should stay out of? Why are you challenging that consensus?
You’re really raising two issues here. First, the United States is often referred to as the “Wild West” when it comes to modern reproductive technologies because there is so little regulation. This field takes a very literal “learning as we go” approach, using human beings as research subjects, often without their consent or knowledge. For example, we have no long-term understanding of the impact of freezing a human embryo, and yet we engage in this practice almost daily without wondering whether this child will suffer any negative consequences as a result of being frozen a year, five years, ten years. A recent article in the British Medical Journal entitled “Are we overusing IVF?” states, “As a society we face a choice. We can continue to offer early, non-evidence based access to IVF to couples with fertility problems or follow a more challenging path to prove interventions are effective and safe and to optimise [sic] the IVF procedure.” It seems pretty rogue of medicine to use human beings with interventions that have yet to be proven safe. Second, I strongly challenge the premise that there is in any way a consensus regarding reproduction and childbearing being private and personal matters that the government should stay out of. In fact, reams of polling data show that in the 41 years since Roe this has remained one of the most divisive and contentious issues in American society.
What is the legal status of surrogacy? Is there any state in which surrogacy, in any form [genetic or gestational], is legally enforceable?
The U.S. has a patchwork of legislation, so one state can vastly differ from another. While one state may as a matter of policy explicitly not recognize surrogate contracts at all, another state may be silent altogether on the matter. Some states recognize paid surrogacy contracts and others permit only altruistic surrogacy contracts. Some states go so far as to criminalize these contracts by fines and/or imprisonment. We have a state-by-state guide on our website, but of course the laws are always changing.
There are two kinds of surrogacy: one in which the surrogate mother has a genetic relationship to the child, one in which she does not. In terms of the overall surrogacy phenomenon, how do these two kinds of surrogacy compare? Do you see any major ethical differences between them?
I don’t find an ethical distinction in either case: Both require the woman’s body for nine months, both demand she surrender that child at birth, both require the risks of maternal health of a pregnancy. The shift is indeed toward what is euphemistically called “gestational” surrogacy, largely so that if the woman has a change of heart and is unable to surrender the child at birth because of attachment, she will have less of a legal claim on the child because she is not genetically linked to the child by her egg and thus will not be seen as the “real” mother.
As in the case of abortion, changing the meaning of words is a necessary first step to overcoming initial hesitations about what one is doing. We use the term “surrogate” to speak of the woman carrying the child. But—at least in the case of genetic surrogacy—she is the mother, not a surrogate. Can you comment further on the language games people play?
Yes, we always seem to want to redefine things to make them more palatable. The surrogate indeed is the mother: She’s the birth mother. Whether she contributes her genetic material or not, without her the child would not be here. Her womb, her body, her blood sustained the pregnancy and allowed the child to be born. If we agree that she isn’t the mother, where does that leave us? It leaves us simply using women as vessels, rented wombs, breeders.
In Breeders, you speak about the reification of surrogates: they become “incubators” or “wombs for rent,” never persons, never really mothers. Expand a little on the phenomenon of how surrogacy depersonalizes women.
Surrogacy is driven by contracts and most often by money. Essentially a woman is hired to perform a service; in this case the service is a pregnancy, resulting in the delivery of a child, who is to be handed over to another person. The infertility industry and those who hire a woman and contract with a woman need to depersonalize her and her role in order to justify using, paying, hiring—whatever word you prefer—her for her services.
There is a moment in the film where the surrogate reports that the woman who would be receiving the child was “too sick” to be bothered to attend the baby’s delivery, and the child’s father found it “awkward” to be in attendance while the child came into the world from a surrogate. Can you relate more about these inhuman aspects of welcoming a person into the world?
When the focus is on what I want, what I need, what I can buy or pay for, we have little need to consider others. Much of what I see and read in the area of third-party reproduction highlights this sort of entitlement, a right-to-a-child mentality. That trickles down to a lack of care and concern for both the surrogate mother and the child. Or, at the other end of the spectrum, the surrogate is sometimes elevated as “an angel.” While this may assuage our guilt, it can mask the humanity of the surrogate in ways that deny the mother-child bond. Now this is not to say we just need to treat surrogates better, rather it is to say that when our focus is on getting our own needs met, it doesn’t bode well for our genuine concern and care for others.
Eugenics seems not to play as prominent a part in surrogacy as it does in egg donation: In Eggsploitation, you note that ova harvesters are looking for healthy, college-educated women, but Breeders observes that the industry is less focused on such high achievers, e.g., there is a greater interest in relatively very young military wives. What issues do you see here?
When the baby is a product and we are spending a lot of money in order to have this baby, we see a juxtaposition. First, we want an “elite” donor for the egg in order to pass on her good genes to the child, and we want her to look a particular way. For the pregnancy side of the equation, however, you won’t find many Ivy League university students willing to take on a nine-month pregnancy. This means we need to find young women who are willing to engage their entire bodies for a nine-month pregnancy. So this aims at a whole new demographic—low-income young women—of which the military wife is a good target. These women see this as a good opportunity to make much-needed income while staying at home with their own young children. Women in developing nations like India and Thailand are another target.
How much money does surrogacy annually represent in America? Egg donation? Sperm donation?
As these are largely under-regulated practices, it is very difficult to get accurate statistics on them. In addition, currently some of this is done under the radar through Craigslist, Facebook, and other social media forums where people meet up and share or sell their eggs, sperm, and wombs. It is definitely a growing industry, though, especially as third-party conception grows in popularity and with the liberalization of same-sex marriage laws. One report states that by 2020, the IVF industry will be a $21.6-billion-dollar-a-year global enterprise!
Anonymous Father’s Day, your film on sperm donation, interviewed children born of that technique, who called for bans on such anonymous fatherhood and the lucre associated with it. The children are not so prominent in either Eggsploitation or Breeders. Can you talk a little about surrogacy from a child’s point of view?
First, many children aren’t told how they were conceived. That is even truer when a woman uses an egg donor in order to conceive but carries the pregnancy for herself. Her child grows up hearing of when mommy was pregnant or when mommy went into labor, so it is much easier to hide all the facts from the child. Second, these are still relatively new technologies, and many of the children are only now becoming young adults who are openly discussing their conception stories. In Breeders we do interview a young woman born via surrogacy who blogs and speaks about her own personal views on being “a product of surrogacy,” as she calls it.
We live in a world seemingly set on a search-and-destroy mission against handicapped or deformed children. Can you give us more information about what happens when a child is found to be “defective?” In your film, the surrogate was the one party defending the supposedly deformed child’s life. What does this often look like in surrogacy arrangements?
As a practice heavily driven by contracts, scenarios like this are generally accounted for within the language of the contract. For example, a contract may state that if the intended parents find out the child conceived has an illness, then the surrogate must terminate the pregnancy and abort the child. In one case, the intended parents split up and told the surrogate she had to terminate the pregnancy, not because there was anything wrong with the child, but because they just didn’t want the child anymore. Again, when it is all about the adults’ wants and desires, the contracts closely guard their interests and to a lesser degree the surrogates’ interests. The children often end up on the losing end.
While advocates of surrogacy believe that such arrangements can be dealt with in purely contractual/economic terms, the mother-child bonding experience almost inevitably enters into and complicates those arrangements. What did you learn about this aspect of surrogacy in making this film?
I was a pediatric nurse for nearly two decades, so I knew going in that the mother-child bond was real, important, and healthy for both the mother and the child. Science is teaching us more and more about the importance of the nine months in the womb to mother and child. We really wanted our audience watching the film to appreciate this bond. I feel we often aren’t thinking about the importance of this bonding and the negative impact it has on both women and children when we intentionally sever it. When we want something so badly, or think we are entitled to a baby and have a right to it, our human nature often doesn’t want to look at counterevidence or even at simple facts that might interfere with our ability to justify our behavior to ourselves as good and right. We call it a win-win for all, but the baby’s feelings aren’t truly considered, because we tell ourselves that as long as the baby is loved and wanted that’s all that matters.
Is it fair to say that surrogacy is another example of adult desires trumping the good of children?
OK, but haven’t we learned—from the incredible staying power of Roe, from the Supreme Court’s dicta in Casey that women “have organized intimate relationships and made choices . . . in reliance on the availability of abortion . . . ,” from the failed impeachment of Bill Clinton because “it was just sex”—that when it comes to what grown Americans want to do with their sex lives, they might brook a little moral agonizing but no legal prohibitions, that politicians won’t enact those bans, and that our elite courts won’t let them stand even if they do? Given the seeming “third rail” nature of public policy when it comes to matters moral and sexual, what do you think can practically be done about surrogacy? Aren’t we stuck with the status quo of the “Wild West?”
Our films are intended to be a practical approach to educating the general public on third-party reproduction. Yes, our lawmakers are slow to act here in the U.S., but we don’t need to wait on our lawmakers. For every young woman I meet who was about to sell her eggs, then watched Eggsploitation and decided against it, we’ve done our job. Similarly, with sperm donation and surrogacy. The more we inform the public, the more people will think about using these technologies, telling their friends not to use them, questioning their physician when he or she sends them off to the fertility doctor. There are similarities to our educational efforts on smoking. The minds of many in the general public were changed about smoking long before the government began taking formal steps. In short, just because we can use third-party reproduction in the U.S. doesn’t mean we have to or should.
Can you talk about the overseas surrogacy movement: what it looks like, how big it is, trends, what we might be able to do about it?
Much like the laws in the United States, the overseas situation is also a patchwork of legislation: Some countries ban it altogether, some prohibit only its commercial aspects, while others are “everything goes.” Thailand, for example, is a growing destination for surrogacy because of its lax laws. I work with colleagues all over the world who see surrogacy as exploitative for women and children, and who are working hard to oppose it. But surrogacy is big business with a growing demand. It is an uphill battle to be sure!
In a March 2014 Hastings Center Report article, Dr. Inmaculada de Melo-Martín contends that children have no “fundamental moral right to know their genetic origins,” that no studies conclusively establish that such information is vital to identity formation or healthy self-awareness, and that denying anonymity can actually represent “harms” by “encouraging problematic belief about the superiority of biological families” to the detriment of “donor-conceived individuals.” In light of your own work, do you have any response to her assertions?
Of course, kinship is important. People are fascinated by their genealogy. They want to probe their “roots.” The most cursory survey of the Internet shows the brisk interest of organizations like ancestry.com and many private DNA companies that help people find lost relatives. This isn’t about “genetic origins.” It’s about knowing who one’s father or mother really is. Should that idea really be open to dispute?”
What are your plans for Breeders?
The film was released in mid-January 2014. We are currently entering many film festivals to raise awareness of the film and get it before wider audiences. We are also organizing a number of screenings across the United States, and we are happy to see that the film is being purchased in several other countries as well. We have a full schedule of showings around the United States. Breeders is also available on vimeo on-demand, which allows anyone with a computer and Internet connection to watch it anywhere/anytime! See vimeo.com/ondemand/breeders/
Breeders is coming to New York and Washington. Tell us more about its Big Apple debut.
We have rented the BowTie Theater (260 West 23 Street) in New York City on Wednesday, June 18, to screen the film at 7:00 pm. Several people from the film will be on hand for a discussion with the audience after the screening. The following night we will host a screening in Washington D.C., at the Landmark Theater on E Street.
. 3380 Vincent Rd., Suite Hub, Pleasant Hill, CA 94523-4324; telephone 925-407-2660.
. Inmaculada de Melo-Martín, “The Ethics of Anonymous Gamete Donation: Is There a Right to Know One’s Genetic Origins?” Hastings Center Report, 44 (2014), no. 2: 28-35.
 See breeders.cbc-network.org/ under “Screenings.”