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Globalization and cross-border reproductive services: Ethical implications of surrogacy in India for social work

Globalization and cross-border reproductive services: Ethical implications of surrogacy in India for social work
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  See discussions, stats, and author profiles for this publication at: Globalization and cross-border reproductive services: Ethical implications of surrogacy in India for social work   Article   in  International Social Work · August 2010 DOI: 10.1177/0020872810372157 CITATIONS 30 READS 604 4 authors , including:George PalattiyilThe University of Edi… 5   PUBLICATIONS   59 CITATIONS   SEE PROFILE Geeta BalakrishnanCollege of Social Wo… 1   PUBLICATION   30 CITATIONS   SEE PROFILE All content following this page was uploaded by Geeta Balakrishnan on 09 July 2014. The user has requested enhancement of the downloaded file.  International Social Work online version of this article can be found at: DOI: 10.1177/0020872810372157 2010 53: 686 International Social Work  George Palattiyil, Eric Blyth, Dina Sidhva and Geeta Balakrishnan implications of surrogacy in India for social workGlobalization and cross-border reproductive services: Ethical  Published by: On behalf of:  International Association of Schools of Social Work   International Council of Social Welfare   International Federation of Social Workers  can be found at: International Social Work  Additional services and information for Email Alerts: Subscriptions: Reprints: Permissions: Citations: at Monash University on February 13, 2011isw.sagepub.comDownloaded from    Article  i s w Corresponding author: George Palattiyil, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15A George Square, Edinburgh EH8 9LD, UK. Email:  International Social Work 53(5) 686–700© The Author(s) 2010Reprints and permission: 10.1177/0020872810372157 Globalization and cross-border reproductive services: Ethical implications of surrogacy in India for social work  George Palattiyil University of Edinburgh, UK Eric Blyth University of Huddersfield, UK Dina Sidhva University of Edinburgh, UK Geeta Balakrishnan University of Mumbai, India Abstract Surrogacy in the context of cross-border care has hitherto received little attention from the international social work community. In India, the provision of surrogacy services for foreign couples may be seen as part of the country’s wider health tourism industry. This article overviews current evidence on surrogacy in India, and discusses the extent to which proposed legislation, the Assisted Reproductive Technologies (Regulation) Bill and Rules 2009, satisfactorily addresses social workers’ concerns to ensure adequate protection of the interests of young Indian women engaged in surrogacy, as outlined in the International Federation of Social Workers’ policy on cross-border reproductive care.  at Monash University on February 13, 2011isw.sagepub.comDownloaded from   Palattiyil et al. 687 Keywords cross-border reproductive care, globalization, health tourism, India, International Federation of Social Workers, surrogacy Introduction Every night in Anand, a quiet Indian city, 15 pregnant women prepare for sleep in the spacious house they share, ascending the stairs in a procession of  ballooned bellies, to bedrooms that become a landscape of soft hills. A team of maids, cooks and doctors looks after the women, whose pregnancies would be unusual anywhere else but are common in this part of India. The young mothers of Anand … are pregnant with the children of infertile couples from around the world. (Dolnick, 2008) Following market liberalization in the 1990s, India’s economy has witnessed rapid development (De Rato, 2005; Hutchison, 2008; Panagariya, 2008; Sen, 2007), enabling it to compete successfully with the world’s more developed economies. The development of private health care has been one of India’s most remarkable achievements so that, with explicit government encourage-ment, it has emerged as a ‘global health destination’ (Chinai and Goswami, 2007), making health tourism the country’s second most popular industry (India Health Visit, n.d.). With highly trained, English-speaking, staff (usually having received their training in an English-speaking country), well-equipped hospitals and speedy access to treatment, private medical services are comparable with similar services provided in more economi-cally developed countries, but at a substantially lower cost, offering: ‘first world treatment at third world prices’ (Health Tourism India, n.d.). Substantial though the development of India’s health tourism industry has been, further expansion is predicted; the total health-care market is expected to expand  by 2012 from US$22.2 billion (5.2% of GDP) to US$50–69 billion (6.2– 8.5% of GDP) (Chinai and Goswami, 2007). Within the same time-frame, India’s share of the global medical tourism industry is anticipated to grow to around 2.4 percent, with the annual number of medical tourists expected to top one million (Bharat Book Bureau, 2009). Health-care tourism and health care for the indigenous population The state of private health care, however, stands in marked contrast to the reality of health care for the majority of India’s indigenous population, especially those living in rural areas. There are barely four doctors for every 10,000 inhabitants (  Hindustan Times , 2007). According to the 2005 at Monash University on February 13, 2011isw.sagepub.comDownloaded from   688 International Social Work 53(5) Reproductive and Child Health Facility Survey, less than half of India’s  primary health centres had a labour room or a laboratory, less than one-third stocked essential drugs and less than one-fifth had a telephone connection (Chinai and Goswami, 2007). While providers of services for foreign health tourists are required to charge lower rates for the local population, even these remain beyond the means of many indigenous patients. The impact of health-care tourism on public health services is contested. Advocates of pri-vate health care and health tourism argue that public health services benefit from a trickle-down effect and help prevent the export of skilled personnel out of the country. Critics argue that, nevertheless, the growth of private health care has fuelled the internal migration of skilled health-care workers from rural areas to urban centres, and that benefits accruing to the public health system are negligible. Meanwhile the Indian government is subjected to increasing pressure to use health tourism income to underwrite public health care (Chinai and Goswami, 2007).Such developments are integral characteristics of globalization, a phe-nomenon epitomized by reduced trade barriers that enable individuals who can afford to do so to transcend national boundaries to secure goods and services from more or less anywhere in the world, expedited by modern ICT facilities and cheap international travel. Infertility, involuntary childlessness and cross-border reproductive care Infertility and involuntary childlessness affect many of the world’s child- bearing population; worldwide, an estimated 40.2–120.6 million women aged 20–44, living in a married or consensual relationship, fail to conceive after 12 months of unprotected sexual intercourse: of these 12–90.4 million are likely to seek medical help (Boivin et al., 2007). While a variety of reproductive procedures is available for different forms of infertility and involuntary childlessness, this article focuses explicitly on surrogacy. Practices akin to surrogacy have been reported throughout history. The Bible   (Genesis 16:1–4) describes a form of genetic surrogacy (where the surrogate is also the genetic mother of the child). However, this – and other Biblical instances – differs from more recent forms of genetic surrogacy in so far as the surrogate is conceived following sexual intercourse with the genetic father as opposed to inseminating non-coitally. Second, the surrogate, invariably a household servant, seems to have had little choice regarding her participation. Gestational surrogacy, a more contemporary variant, utilizes modern reproductive techniques to create an embryo using the egg and semen of each genetic parent (although donor egg and/or semen could at Monash University on February 13, 2011isw.sagepub.comDownloaded from 
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