One of the most enduring impressions left on me following my travels through southern India last year was the primacy of family for all strata of society. 

Mid-conversation, and sometimes apropos of nothing, young men would flip open their cell phones  to show me a picture of their kids– an obvious source of pride and joy. When I told one young girl that I didn’t have any children her spontaneous “Why?!” was as touching for its candor as it was telling that this was a society where love & marriage is supposed to be followed by a baby carriage. Metaphorically speaking, at least, because in spite of crossing paths with thousands of babies and toddlers throughout Tamil Nadu, Karnataka, Maharashtra, Kerala and Goa. I did not see one child relegated to a Bugaboo, Chicco Key Fit or Baby Björn. On the contrary, children were always transported via the loving arms of a mother, father, grandparent, sibling, uncle, auntie or cousin.

I’d be hard pressed to name a culture which does not espouse family values, but I’ve yet to see a support system for new parents anywhere which rivals that of the extended family in India. Even when couples have trouble conceiving a child the heartache is not theirs alone to bear, as evidenced by scenes like the one pictured below where families pining for a baby tie colorful swatches of fabric to tree limbs to symbolize their hearts’ deepest desires.

For all the stories of abject poverty coming out of India, the truth is that children are as great an emblem of wealth as any; which why a story I recently came across on PBS’s website struck me as incongruous.

In the second of a two-part series, PBS Newshour correspondent Fred de Sam Lazaro reports on a clinic in Western India where poor local women are paid to act as surrogates for (relatively) wealthy foreigners. Based in the small town of Anand, the Akanksha Infertility Clinic is run by Dr. Nayna Patel, who characterizes the exchange as “win-win-win.”

That the situation has been a win-win for Dr. Patel and the biological parents coming from India and abroad is indisputable. A leader in what is now a half-billion-dollar industry in India, Patel has delivered over 400 babies since 2004. At a cost of $10,000 – $15,000 the bottom line for biological parents is a fraction of the $110,000 they might expect to pay a surrogate in the US. Commissioning parents typically have contracts written to protect their interests, and the practice of implanting up to five embryos (the final tally is winnowed by selective abortion should all embryos result in viable pregnancies) in India serves to maximize the chances of pregnancy. Given the usual protocol in the US of implanting no more than two embryos to minimize risk to mother and child, it’s easy to see why women like 46-year-old Kirshner Ross-Vaden would choose to realize her dream of parenthood so far from home. “Coming here to India, these women, they don’t want my child”, says the Colorado native. “It’s very cut and dry. They do not want my child. They want my money. And that is just fine with me.”

But is it just fine with the surrogates?

What, besides the $7,000 – $8,000 paycheck for a pregnancy carried to term, makes this such a winning proposition for the birth mother? Who advocates for her in the event of a complication or long-term injury resulting from pregnancy or delivery? What are the cultural ramifications for a surrogate when she finds herself handing over a newborn in a society that has raised baby love to an artform? And while Dr. Patel mandates that all surrogates move into a pregnancy hostel where they receive prenatal care from the moment a pregnancy is confirmed through delivery, by definition this means that surrogates must abandon their own families for nine months in order to make someone else’s dream of a family come true. (One prerequisite for becoming a surrogate stipulates that all candidates must have given birth to a biological child prior to being hired by Dr. Patel.)

Barring any questions on morality and ethics, I have a hard time reconciling the lopsided arrangement in which biological mothers like Ross-Vaden make tepid claims of wanting to keep in touch her surrogate– “I do have her address, so I can get a hold of her. And hopefully I will be able to maintain some kind of relationship with her”– as the surrogate acknowledges her powerlessness in the relationship. “You can’t help it when you’ve carried a baby for nine months”, says the woman who bore Ross-Vaden’s daughter. “I would like to see how she does in the future.” (Something tells me the contact information exchange is not quid pro quo, but I could be wrong.)

Time and again, proponents of surrogacy arrangements site the pain, disappointment and longing that accompanies struggles with infertility as if this alone were justification for achieving parenthood by any means necessary. But should the longings of one woman preclude those of another who is paid to carry a baby to term then hand it over in a supposedly “cut and dry” transaction? The language alone belies the commodification of the sacred. And while women are not generally known for their defense of prostitution– which, after all, is simply the exchange of money for the use of another’s time and body– I am astonished at the rationalizations that flow from this same demographic when it comes to hiring another woman’s womb to grow a baby as if the surrogate’s heart and soul were not part of the equation.

For all the arguments of free will, self-determination, altruism and how $7,000 can change the life of an impoverished woman in India, there is no getting around the fact that when a surrogate’s choices are driven by economics alone– that’s what’s known as a losing proposition.