Book Review

Surrogate Motherhood and the Politics of Reproduction

N Engl J Med 2008; 358:651-652February 7, 2008

Article

Surrogate Motherhood and the Politics of Reproduction
By Susan Markens. 272 pp. Berkeley, University of California Press, 2007. $60 (cloth); $24.95 (paper). ISBN: 978-0-520-25203-5 (cloth); 978-0-520-25204-2 (paper).

Surrogate Motherhood and the Politics of Reproduction presents a fascinating history of the influences that have shaped surrogacy laws and practice in the United States. Markens, a self-described feminist sociologist, presents her view that the development of surrogacy over the past two decades has been influenced by the cultural and political landscape. This is a timely commentary. According to the Society for Assisted Reproductive Technology, approximately 250 children were born by means of surrogates in 2005. Despite the growing numbers of Americans engaging in “third party reproduction,” there is no U.S. consensus about the practice of surrogacy, either in health policy or in law. The United States stands alone in this position; many other countries have been more definitive about allowing or prohibiting surrogacy.

For Markens, the unique landscape of American surrogacy policy and law is a product of the dynamic between several key players: the media, women's organizations, feminist groups, and religious groups and other passionate legislative lobbyists. The story unfolds over the course of six chapters and uses the diverging evolution of surrogacy legislation in New York and California to highlight the complexity and diversity of arguments for and against the practice of surrogacy.

William Stern Holding His Daughter, Then Known as Baby M, after Her Visit with Her Birth Mother, Mary Beth Whitehead, in Hackensack, New Jersey, January 16, 1987.

Markens begins the narrative with a description of how surrogacy evolved into a “social problem,” rather than a welcomed solution to help infertile couples have children. Early on, issues of surrogacy sparked controversy primarily because they ran in parallel with a larger, ongoing debate about the changing notions of women, family, parenting, and motherhood. The media played a heavy hand in setting the stage for this new way to create families. Media coverage of early controversial legal cases, such as that of Baby M, brought attention both to the “horrors” that this new construct of the family could produce and to the hope it brought to relieve what was viewed as the plight of the infertile couple. Race and socioeconomic status were also important but often silent factors in the social and political response to women's decisions to become surrogates. Markens provides evidence that surrogates were often in a social and financial situation that was very different from the recipient parents, as they typically were among the poorer and disadvantaged subsets of the community. These portrayals of surrogacy polarized the American public and, in turn, influenced the local political arena in equally impassioned ways.

In the political forum, language became a very powerful tool in shaping the debate about the “social problem” of surrogacy. Markens demonstrates that much of the dialogue about surrogacy was articulated in the rights language of the abortion debate. Familiar and evocative phrases, such as “women's reproductive rights,” “women's choice,” “fetal rights,” and “children's rights,” were used by all stakeholders, regardless of what end of the surrogacy spectrum they represented. Markens describes how this language varied in meaning and intention when used by the different key players, contributing to the greater picture of indecision among state and national leadership.

This commentary, though insightful and important in its current form, would have benefited from some discussion about how politics and culture determined public policy on surrogacy in other areas of the world. In all fairness, the objective of the book is to concentrate on reproductive politics in the United States, but with the increasing globalization of medicine, we must factor the perspectives of international communities into our own perception of assisted reproductive technology. Given the changing demographics of this country, these issues cannot be left aside.

Markens has written a fascinating book about the historical development of surrogacy policy. This is an important body of knowledge for professionals in the practice or study of women's health, reproduction, and assisted reproductive technology. Reflection on the lessons from our political and cultural past will most certainly come into play in the future as new methods of reproduction are developed.

Tommaso Falcone, M.D.
Ruth M. Farrell, M.D., M.A.
Cleveland Clinic Foundation, Cleveland, OH 44195
farrelr@ccf.org