Reproductive Tourism

A recent article in the New York Times describes the discovery of birth houses in San Gabriel, California, where “relatively wealthy” Chinese women were stealthily coming to deliver their babies in a well-equipped facility with nursing care. The headline, “Arriving as Pregnant Tourists, Leaving with American Babies,” with its subtle innuendo, speaks to the nefarious purpose of such births: to create automatic American citizens. The text, with its reference to “prenatal vitamins…tucked into rice cookers” sketches a picture of the illegally interconnected townhomes as distinctively Asian (who else eats rice, after all?). And use of the term “tourism” conjures an image of rich, foreign women on holiday, stopping by to pop out a fresh, new American citizen before heading out to the mall.

A 2008 article in the Montreal Gazette deploys the term maternity tourism (also called birth tourism) to describe the phenomenon: “wealthy mothers from other countries come to a rich, stable country to give birth, bestowing upon the born a coveted citizenship.” The article’s author, struggling mightily not to appear judgmental (the woman in his story is not even a maternity tourist, as he acknowledges), nonetheless follows the definition with this statement: “Sometimes…medical bills are not paid.” This Canadian publication does not mount the kind of hysteria one sees in U.S. newspapers along the United States – Mexico border, and the author even speaks to humanitarian needs; but the bottom line is that maternity tourism leaves “its share of unpaid bills”; “Quebec hospitals lose about $20 million a year to non-residents”; and “You can see why doctors who are cheated get sick of it.”

Much attention has also been paid to surrogacy tourism. For example, in 2010 Mother Jones ran a feature on India’s legal “rent-a-womb business.” Here, well-do-do American, Canadian and other “first world” women travel with their husbands/partners to India to undergo In Vitro Fertilization (IVF), followed by birth of “their” baby via surrogate, at a much lower cost than such services in their own countries. Benefiting from India’s legalization of surrogacy in 2002 in a bid to foster medical tourism, the arrangement is perceived by many (but not Mother Jones) as a win-win situation. Middle-class couples suffering from infertility get to “have” a baby, while poor, rural women are compensated up to several thousands of dollars for their labors. Even America’s pop culture queen, Oprah Winfrey, has weighed in favorably on this poignant “journey to parenthood.”

The broader practice of reproductive tourism, under which maternity and surrogacy tourism fall, has been addressed by journalists, bioethicists, feminists, scholars, and others. There is no one position in response to this seemingly growing practice, although accurate statistics are difficult to locate, given that the targets are moving. Some commentators view reproductive tourism writ large as unethical, while others see it as an extension of historic colonialism. For some, like Winfrey, practices such as Indian surrogacy expand reproductive options, especially for the infertile. For others, renting a womb is seen as the worst kind of human exploitation and an especially pernicious way in which women’s bodies are exchanged for another’s profit. One critic offers two alternative terms to frame these practices, neither of which quite hits the mark: cross-border reproductive care (CBRC), which is devoid of critical analysis; and reproductive exile, which sounds promising in terms of human rights but is vague and erroneously evokes the biblical.

Rather than attempt to finesse the complex ethics of reproductive tourism here (although these should be widely debated), I suggest that we interrogate the widespread use of the term “tourism” to describe transnational reproductive phenomena. In the commentaries cited above, despite offering varied accounts, none of the authors critique the language of tourism. This is fundamentally a mistake, one that prevents a richer, fuller analysis. Scholars in the emergent field of critical tourism studies extend Malcolm Crick’s distinction between travel and tourism: one travels to discover something about the world, whereas tourism (especially in its mass form) is “experience packaged to prevent real contact with others…a manufactured, trivial, inauthentic way of being.” By this definition, “tourism” could certainly describe empty commercial transactions, such as surrogacy in India. Reproductive tourism is fast becoming a kind of mass tourism for the privileged.

But at the same time, tourism implies a kind of mindless, benign movement through the world; if one participates in a “manufactured” experience, then perhaps one is not especially cunning or adventurous. According to the tourism studies literature, the real travelers are those who go “off the beaten path” with Lonely Planet guides and global positioning systems (GPSs) in hand, eschewing the usual tourist hangouts. Real travelers do not join group tours nor do they visit insincere, crass cultural sites like Disneyworld and Dollywood. Real travelers are self-consciously aware of the marks they make on the world, and they strive, like Girl Scouts in the wilderness, to leave things as they found them. In contrast, while tourism is seen as inauthentic and potentially dangerous to the planet, tourists themselves are perceived as simply blundering through—picture Chevy Chase in European Vacation—engaging in damaging yet good-natured fun.

To describe complex, global reproductive transactions as tourism, then, is to grossly misrepresent the human agency driving these practices and the significant consequences that result. In relying on the trope of tourism, journalists and scholars alike reduce all women’s choices, life histories, embodied realities, desires and hopes, fears and regrets, and social circumstances to the two-dimensional image of Julia Roberts in sunglasses strolling confidently through the streets of Rome with an expensive leather bag tossed over her shoulder. Eat, Pray, Love…and make (or buy) babies? But let’s ask ourselves: Are Chinese women who desire long-term security for their children and themselves in older age really “tourists”? If American women seeking surrogacy services are framed as tourists, then does this render the Indian surrogate a cultural heritage site, with her own entry in Fodor’s India? Is it tourism when a struggling young couple travels to another country to give birth because the health care system there is better?

We should challenge use of the term reproductive tourism because many people categorically cannot be considered tourists. For example, the tenor of anti-immigration debates in the Southwestern United States and elsewhere means that Mexican immigrants to the United States are never simply tourists. In one version of the story, they are hard-working people striving to ensure a better life for themselves and their families. In a competing version of the story, they are opportunistic foreigners, most likely drug dealers or related to drug dealers, who steal jobs from citizens and erode the American Dream with their dangerous ways. Yet the reality is that they may be legal residents of the United States traveling across the border or people actively pursuing citizenship. Because most Americans cannot imagine Mexican visitors to the United States as tourists, we do not get stories of mutually beneficial reproductive tourism, like those of middle-class white people traveling to India in neocolonial fashion to hire a surrogate. Instead we get diatribes against the “anchor baby” phenomenon. The U.S.-born babies of Mexican immigrants are not, in these accounts, actual human beings, but rather technologies used by their parents to embed themselves and their voracious economic needs and foreign culture deeply into American bedrock.

Reproductive tourism conceptually flattens the jagged, embodied terrain that Shellee Colen called stratified reproduction. Use of the term “tourism” precludes a focus on power and the many ways the world’s women continue to be profoundly unequal. While some privileged Americans can afford to rent another human being’s body to produce a child, others cannot afford to rent a place to live and to shelter their own children. Wealthy women from another country travel thousands of miles to give birth, but do so in Los Angeles County with its rising infant mortality rate. Mexican women migrating to the United States are not, in fact, uniformly protected by the “Latina paradox”; their migratory journey is uniquely harrowing, with numerous risks to themselves and their babies. Indeed, none of these women are tourists in any meaningful way; and yet their existence prompts elected officials and pundits to speculate about the possibilities of barring pregnant women from entering the United States.

So, then, how might we name the contentious, ethically suspect modes of global reproduction described in terms of recreational travel? I want to suggest that we use the term transnational reproduction to refer specifically to bodies, practices, technologies and forms of capital that cross national borders. Such reproduction is certainly stratified. But insisting also on transnational aspects, as Carole Browner and Carolyn Sargent do in their new volume, draws attention to relations between and among countries, systems of commerce and global regulatory systems (or lack thereof), and not only between women with money and those without. Examining contemporary “touristic” practices such as renting wombs in developing nations, we can (and should) ask: In what ways are these practices transnational? In what ways are they reproductive? How do they connect to processes of nation building and other geopolitical arrangements? Under what conditions do they both rely on and foster injustice? And how do they sustain social stratification at local, regional, national, and global levels?

At the same time, we need to specify exactly the roles that people play in reproductive transactions. People who purchase space inside a woman’s body in another country are not tourists; they are consumers. Men who participate with their partners/wives in these practices are also culpable; they are not merely bystanders, and to ignore their role frames women as the only agents who matter. An Indian woman who rents out her uterus to others is a surrogate, but she is also a daughter and perhaps a mother. A wealthy Chinese woman who gives birth in California is a traveler, but she is also a patient, a laboring woman, a consumer and a mother. A lawyer in New York who facilitates transnational adoptions is also a broker. And a Mexican-American baby in Arizona is neither an anchor nor a drug dealer nor a destroyer of the American Dream; she is somebody’s precious child, and she is a citizen under the U.S. Constitution.