Jennifer Lahl brings her nursing expertise to the conversation about surrogacy with her new documentary, Breeders, a project of the Center for Bioethics and Culture Network. Breeders opens a window into surrogacy and its devaluing and demeaning of women and life, showing the details of an industry in which realities are often masked by unobjectionable words like “hope,” assuming the best of intentions and practices. In an interview with National Review Online’s Kathryn Jean Lopez, Lahl talks about Breeders, surrogacy, and her hopes for the future of reproduction technology. (Full disclosure: Lopez has endorsed the documentary.)
JENNIFER LAHL: Much of my work is in the space of reproductive technologies, and specifically what is called third-party reproduction (using eggs, sperm, or wombs of other people to have a baby). Breeders is the third and final film in this series. First was Eggsploitation, which looked at the lives and stories of women who sold their eggs for much needed money, and who suffered serious health complications as a result. Then we released Anonymous Father’s Day, telling the stories of adults created via anonymous sperm donation. We felt it was important to tell the whole story of third-party reproduction, which compelled us to tell the surrogacy story in Breeders.
Lopez: Who is your audience?
Lopez: Isn’t surrogacy about hope and any criticism about it insensitive to infertility?
Lahl: Well, that is certainly how the supporters of surrogacy feel about it. There is a case now in Utah where a 58-year-old woman is the surrogate for her daughter, basically giving birth to her own grandchild. The comments on this case are mostly about the miracle and the amazing thing this woman is doing for her daughter. It is often the case that those like me, who are critical of the practice, are seen as insensitive and lacking compassion for those struggling to carry a child to term. I am very sympathetic to those struggling with infertility; it is tremendously painful. But we would be remiss if we only looked at the issue from the perspective of those who want a baby. What about the needs and concerns of the child? What about the use of women — very often women who are of low income — as surrogates, which some refer to as incubators, breeders, and even Easy-Bake Ovens? What about the commercialization and commodification aspects of what is now a multi-billion-dollar-per-year fertility industry? Much of my work is trying to tell the full story, the whole story, which requires that we face these questions and not avoid them because someone so desperately wants a baby.
Lopez: What’s the important connection to Eggsploitation? (And what does it mean to eggsploit?)
Lahl: It is often the case in surrogacy that “donor” eggs are used. There has been a shift in surrogacy. We’re moving away from the traditional method of surrogacy, where the surrogate is both the birth mother and the genetic mother (think Baby M case), to what is referred to as gestational surrogacy, meaning the surrogate supplies her womb but the egg comes either from the intended mother or from a “donor.” Male same-sex couples need both an egg donor and a surrogate in order to have a child. The shift toward gestational surrogacy is a deliberate move made for legal reasons. The less a woman can claim a link to the child (i.e., a genetic link), the less intended parents worry that the surrogate will be allowed to change her mind.
In addition, intended parents may feel they have a stronger legal case against a surrogate if she should change her mind about giving up a child to which she has no genetic connection. Of course, who then is looking out for the child? In particular, what is the impact of being in the womb for nine months and immediately being separated from the only person that the baby has ever known? We’ve learned from adoption history that babies know their birth mothers, and that both mothers and babies experience a loss from such separation.
To eggsploit means to literally use women for their eggs. Egg “donation” (in reality, egg selling) has serious, real, short- and long-term health risks. It is scandalous that we allow young women to be paid to undergo a risky procedure, corrupting their health decisions with a check for $5,000, $10,000, or more. When people watch Eggsploitation, I’m overwhelmed with how many in the audience are woefully uninformed about this practice and how many are alarmed when they discover that it is legal.
Lopez: What are the fundamental questions we need to ask about assisted reproduction? Who should be asking and how?
Lahl: Should we be doing this at all? seems a fundamental question in my mind. Do we have a right, a fundamental right, to have a child? What limits should be in place for people using these new technologies to have a child? These are questions we all should be addressing. As a nurse, I’m disappointed the medical professionals aren’t encouraging this conversation. And our lawmakers must see these as important and serious questions to be wrestling with. As it is now, these messy cases get caught up in our courts in order to decide who gets the baby, or who the rightful or legal parent is.
Lopez: It’s hard to ask these questions, isn’t it, when so many Americans seem to have made use of some kind of assisted reproduction? If you’re in a classroom teaching, how many students could be products of these technologies?
Lahl: Yes, it is hard work. I’ve been surprised just how hard it is because the emotions are so real, so deep, and yes, everyone either has used or knows someone who has used these technologies to conceive. Often when I speak to a large audience I will say that I know many in the room have used these technologies, are here because of these technologies, or may be here because of these technologies but don’t even know it (many people don’t tell their children they were born via donated eggs or sperm).
Lopez: Hasn’t this all gone too far for it to be possible to roll anything back?
Lahl: We have a history, at least here in the U.S., of making large-scale changes in thinking and behavior. Smoking is a good example of a product that was rolled back because we became aware of the risks and harms. Seatbelts in cars is another example of a large-scale change. I’m old enough to remember standing up in the backseat of the car when my family went somewhere. My hope is that as we are now increasingly seeing the fallout and the negative consequences for both women and children, we will begin regulating these technologies like many other countries have done.
Lopez: How much does gay marriage factor into the questions Breeders raises?
Lahl: The majority of people using surrogates are heterosexual couples, but with the growing acceptance of same-sex relationships, homosexual couples too are seeing this as a way to have a child of their own.
Lopez: How important is the maternal-bonding question to surrogacy?
Lahl: I was a pediatric nurse for nearly 20 years, and the bonding issue is a real concern of mine. As a nurse I worked mostly in the intensive care unit, and we worked so hard to keep moms with sick preemie babies connected and attached because that bond is so important. We are learning more and more about all the important things that happen those nine months in the womb, but in surrogacy we simply ignore the importance of maternal-child bonding, treating it as irrelevant because someone who desperately wants a baby gets one.
Lopez: Should there be any exceptions? Are there conditions in which surrogacy is a merciful option, like if a sister wants to help a brother and sister-in-law, etc.?
Lahl: Again, although I have compassion on those who can’t carry a child to term, I don’t think the ends justify the means. We can’t predict how these situations will end up. One of the women we interview in Breeders was a surrogate for her brother, and that went terribly wrong. I’m in the process of interviewing an egg donor now who has just been diagnosed with cancer. A surrogate I know lives with daily regret knowing the child she surrendered is in a less than loving home. The Baby M case is the classic case of a woman who changed her mind and couldn’t surrender the baby. I want to build a society where we want mothers to connect with their babies and not turn their bodies into objects to be used, bought, or sold.
Lopez: What’s the unique voice you bring to this as a nurse?
Lahl: My expertise is unique because I can speak to the real risks and harms of the drugs and procedures used on women. I understand the medical problems that children have who are conceived through reproductive technologies. Many seem to think this is all so easy and that a woman just donates eggs, loans out her uterus, and a baby almost miraculously appears (as if carried in by a stork). As a pediatric nurse, I have expertise in maternal-child health. And I understand the use of and corruption of informed consent. In my 20-something years of nursing, I never watched someone give truly informed consent to medical risks while staring at a check for $20,000–$30,000, which is what a surrogate can easily make.
Lopez: What Breeders story is most compelling to you? Whose testimony do you wish everyone would listen to?
Lahl: That’s a hard question. Maybe it’s because I’m a female documentary filmmaker, but I just fall in love with all of the people I interview in my films. Their stories, bravely told, are each so very compelling. They all started out wanting to really help someone, but things went so terribly wrong. Heather is so vulnerable as she talks about being told to abort the baby she was carrying but refusing. Tanya, who closes the film — when the cameras were rolling and she was telling her story, I just knew we had the ending to the film! Cindy’s case is gut-wrenching, as she was truly used by a man to have babies for himself and his partner. Gail, who was the surrogate for her brother and his partner, has an important story, since people think surrogacy within families is the best or only way to go. Her case demonstrates that even then everything can go terribly wrong.
Lopez: Is this a women’s-rights issue? A health issue? A human-rights issue?
Lahl: Yes, yes, and yes! It is a women’s-rights issue, which is why I’ve been able to get such support for my work from a diverse range of leading international feminists. It is definitely a health issue: the risks of the technologies, the drugs, and the separation to both the women and the children. And it’s a human-rights issue, especially when you see how poor women in India, Thailand, or Mexico are treated. Often these are illiterate women who can’t even read the contracts they’re agreeing to. They are truly impoverished and simply cannot be making free and informed choices in such circumstances.
Lopez: As a political issue: What’s next and realistic to do?
Lahl: Part of our educational work is directed toward lawmakers. Last year we saw legislative successes in Minnesota on a surrogacy bill. We were influential in Louisiana, where Governor Bobby Jindal vetoed a surrogacy bill. Governor Jerry Brown vetoed a bill that would have allowed researchers to pay women for eggs in my state of California. We are watching a bill in the District of Columbia that would make surrogacy legal there. These aren’t issues that politicians gravitate toward, though. No one makes third-party reproduction one of their platform goals.
But I believe our best contribution is educating ordinary people so that they will think twice about these practices. I’ve met several young women who were thinking about selling their eggs but watched Eggsploitation and it changed their minds. I hope Breeders will have the same impact.
Lopez: What does a parent say to a child who was conceived through exploitation of a poor woman?
Lahl: Honesty is still the best policy. I’m a believer in telling your children as early as they can understand how they were conceived. Acknowledge and accept their feelings of loss, grief, or anger. I’ve learned a lot from my friends who were conceived through anonymous sperm donation and also the young woman in Breeders born via surrogacy. They really are truly happy to be alive, but they want (and are right to want) and need validation of their real feelings.
— Kathryn Jean Lopez is editor-at-large of National Review Online.