Birthing a mother: the surrogate body and the pregnant self

Birthing a Mother This page intentionally left blank Birthing a Mother The Surrogate Body and the Pregnant Self Elly Teman UNIVERSITY OF CALIFORNIA PRESS Berkeley . Los Angeles . London University of California Press, one of the most distinguished university presses in the United States, enriches lives around the world by advancing scholarship in the humanities, social sciences, and natural sciences. Its activities are supported by the UC Press Foundation and by philanthropic contributions from individuals and institutions. For more information, visit www .ucpress.edu. University of California Press Berkeley and Los Angeles, California University of California Press, Ltd. London, England © 2010 by Elly Teman Library of Congress Cataloging-in-Publication Data Teman, Elly. Birthing a mother : the surrogate body and the pregnant self / Elly Teman. p. cm. Includes bibliographical references and index. isbn 978-0-520-25963-8 (cloth : alk. paper) isbn 978-0-520-25964-5 (pbk. : alk. paper) 1. Surrogate mothers—Israel. 2. Mothers—Israel. 3. Pregnancy—Israel. 4. Judaism. I. Title. hq759.5.t46 2010 306.874'3—dc22 2009019426 Manufactured in the United States of America 19 18 17 16 15 14 13 12 11 10 10 9 8 7 6 5 4 3 2 1 This book is printed on Cascades Enviro 100, a 100% post-consumer waste, recycled, de-inked fiber. FSC recycled certified and processed chlorine free. It is acid free, Ecologo certified, and manufactured by BioGas energy. This book is dedicated to my one-of-a-kind mother, Rhisa Teman—adoptive mother to many generations of students, but the only mother for me. And it is dedicated to the memory of my beautiful grandmother, Ruth Ellen Erlich, whom we knew as Sasi. This page intentionally left blank And that’s why I say, I didn’t just give birth to a baby, I gave birth to a mother. Tamar, surrogate I always say, my mother gave birth to me the first time, she gave me life. But my surrogate gave me life the second time. Shlomit, intended mother You are not just giving birth to children; you are giving birth to new mothers and to new and happy families. Mali, intended mother Let your Mother and Father be glad; let she who bore you rejoice. Proverbs 23:25 This page intentionally left blank Contents List of Illustrations xi Acknowledgments xiii Prologue: Yael xvii Introduction 1 part one . Dividing 1. Surrogate Selves and Embodied Others 2. The Body Map 3. Operationalizing the Body Map 31 54 75 part two . Connecting 4. Intended Mothers and Maternal Intentions 5. The Shifting Body 110 134 part three . Separating 6. Rites of Classification 7. The Surrogate’s Gift 184 205 x Contents part four . Redefining 8. The Surrogate’s Mission 9. The Hero’s Quest 238 263 Conclusion 283 Notes 297 Bibliography 335 Index 353 Illustrations 1. Surrogate attached to an incubator 2. Surrogate holding a flowerpot for the couple’s sapling 3. Mug depicting an oven and the popular slogan “Their bun, my oven” 4. Surrogate’s body map 5. Surrogate as an “innkeeper” hosting a family in her womb 6. Surrogate and intended mother sharing the pregnancy 7. Surrogate and intended mother sharing a belly 8. Surrogate and intended mother in a suffocating relationship 9. Surrogate as Superwoman 10. Surrogate as Israeli national heroine 11. Surrogate as pregnant fairy or angel 12. Surrogate being dressed in an angel costume xi 33 34 35 55 59 144 160 167 242 256 269 272 This page intentionally left blank Acknowledgments This book could never have come to completion without generous funding from various sources. Fieldwork and early writing of the manuscript were enabled by generous scholarships from the Canadian Friends of the Hebrew University, the Golda Meir Foundation, and the Social Sciences Faculty Rector’s Prize of the Hebrew University. I also thank the Hadassah Brandeis Institute, the Israeli Association of Academic Women, and the Lafer Center for Gender Studies for research awards in support of this project. Postdoctoral fellowships from the Yad Hanadiv-Rothschild Foundation and from the Morris Ginsberg Foundation enabled me to spend a full academic year at the University of California, Berkeley, to further my training and to complete this book. The Beatrice M. Bain Research Group and the Science, Technology, and Society Center at UC Berkeley gave me a stimulating intellectual environment in which to write. This book came to completion while I was a postdoctoral research scholar at the Penn Center for the Integration of Healthcare Technologies (Penn CIGHT) at the University of Pennsylvania. I am grateful to the center and its staff for supporting my completion of this project. A number of articles based on this research have been published in journals and in edited volumes. Part of the prologue appeared in 2006 in Gardner and Hoffman’s Dispatches from the Field: Neophyte Ethnographers in a Changing World (Long Grove, IL: Waveland Press). Part of part 1 appeared in 2001 in Women’s Studies Quarterly 31 (3&4): 11–34 and in 2003 in Medical Anthropology Quarterly 17 (1): 78–98. xiii xiv Acknowledgments Part of part 2 appeared in 2003 in a chapter in Cook, Sclater, and Kaganas’s Surrogate Motherhood: International Perspectives (Oxford, UK: Hart Publishing, pp. 261–280) and is forthcoming in Body and Society 15 (3). Finally, part of the conclusion was published in Social Science & Medicine 67 (7): 1104–1112. I am grateful to the editors and anonymous reviewers of these publications for their suggestions and feedback. The illustrations in this book have been reproduced with the generous permissions of the following Israeli illustrators: Ruth Gwily, Gila Kaplan, Rutu Modan, Naama Peleg-Segal, David Polonsky, Danna Shamir, and Rhisa Teman. Over the years, a number of scholars have provided invaluable guidance and support. I especially want to thank Eyal Ben-Ari, my dissertation advisor. He has an unmatchable ability to take the jumble of theory, ethnography, and random thoughts presented to him and help one shape it into a coherent outline. I am grateful for this opportunity to formally acknowledge his peerless mentorship. Meira Weiss has been an important mentor from the time I began my M.A. studies at Hebrew University. Meira’s continuous support and encouragement during my fieldwork and her influential perspective on the anthropology of the body are in evidence throughout my work. She encouraged me to publish my work even at its early stages and introduced me to some of the top scholars in my field; to me, this exemplifies feminist mentorship in its truest form. During the course of this project at Hebrew University, I had the good fortune to receive guidance from several people who informally included me as one of their own mentees. Don Seeman helped me formulate my very first thoughts on surrogacy as my final paper in the medical anthropology course he taught; his close readings and comments on various drafts of this manuscript were important to my thinking throughout this project. Tamar Rapoport and Edna Lomsky-Feder generously included me in a reading and research group they mentored for several years with their graduate students. I learned valuable lessons about theory and critical analysis from them and benefited greatly from the support and comments on my writing from the members of the group. My fellow graduate students and the faculty of the department of sociology and anthropology at Hebrew University provided a collegial network during this research. I especially want to thank those who closely read various chapters or drafts of this study, many of whom are also good friends: Svetta Roberman, Lydia Ginzberg, Adi Kuntsman, Limor Darash, Michal Lester, Lauren Erdreich, Omi Leisner, Tali Berner, Tzvia Birman, Danny Kaplan, Tamar El-Or, Nurit Stadler, and Daphna Acknowledgments xv Birenbaum-Carmeli. I am especially grateful to Noa Aploig for reading through the full manuscript. Tsipy Ivry and I were midwives of one another’s studies; in the lonely world of the “via doctoroza,” it is rare that one finds co-mentorship like ours. I hope that people will read our books in tandem for what they reveal about the anthropology of pregnancy. Several North American scholars have been extremely helpful to me and my work. This book would never have come to fruition without the unwavering enthusiasm, guidance, and belief in me shown by the amazing Robbie Davis-Floyd. The influence of her path-breaking scholarship in the anthropology of reproduction is central to the conceptual toolkit used in this analysis. Meeting Susan Martha Kahn through our mutual interest in reproductive technologies in Israel has been one of the greatest perks of this project. She has been an inspiration to me with her scholarship, a wise guide in this study, and a great friend. Charis Thompson was the kindest host a postdoc in a strange land could ask for. Her input into my thinking about reproductive technologies and her comments on this book have been invaluable. Diane L. Wolf read through several drafts of these pages and offered important comments and encouragement. She encouraged me to “go out on a limb” with the conclusion, and I hope that my efforts follow her call. Heather Paxson, Michelle PridmoreBrown and D. Kelly Weisberg also gave detailed and crucial comments on the full manuscript. A writing group at Berkeley, including Kalindi Vora, Neda Antonosky, and Kimberly Tallbear provided a great support system as well. Special thanks to Susan Markens and Simon Bronner for important advice along this journey. The amazing editing work of Linda Forman is evident throughout this manuscript; her work impressed me so much it led me to seek her out five years after working with her on a journal article. I am also grateful to Tzipporah Avraham and Jennifer Morgan for their edits on other versions of the manuscript. Heartfelt thanks to Stan Holwitz, my editor at UC Press, for giving my book a chance and for his true kindness. I also thank the production staff at UC Press, especially Caroline Knapp and Nick Arrivo. Many friends and family are also present behind the scenes of the fieldwork and writing experiences out of which this dissertation grew. My husband Avi Solomon read through many drafts and made incisive comments and editorial corrections. He has always believed in me more than I did in myself, with patience, grace and love. My parents, Rhisa and Nissan Teman, have been the greatest support team I could ask for, holding my hand in times of crisis and celebrating my achievements; my mom also spent many hours editing my grammar and babysitting xvi Acknowledgments my children so I could finish this book, while my dad helped me search for the artists whose work is included in these pages. My godfather David B. Sherman read and commented on papers and drafts, hosted me on my way to conferences, and kept me updated with carefully collected news clippings on important news relevant to my research. He and Roberto Benitez bought me my first business suit for my first international anthropology conference. I am also grateful for the love and support of my beloved grandparents, Ruth (in blessed memory) and Robert Erlich; my brother Adi Teman; and my aunts, uncles, in-laws, and cousins. My aunt Barbara Erlich was especially supportive of my efforts towards this book. My precious children, Uriel Moshe Solomon and Rachela Tilly Solomon, have brought us all so much joy and awarded me an insider’s perspective on becoming a mother. And I could not have made it through the years of this research without other good friends not mentioned above, among them Danna Harari, Liat Ventura, Naama Shay-Catrieli, Rinat Zohar Menachem, Itsik Nachum, Helene Goldberg, Lisa Carlsson, Gretty Shweizer, and Aliza Haas. Finally, it goes without saying in a text such as this that I am deeply indebted to all of those who have opened their lives, homes, and hearts to me in the course of my fieldwork. To preserve their anonymity, I cannot thank them by their full real names, but Ruti, whose courage paved the way for Israeli intended mothers; Michal, who led me into this field; Merav, who opened the doors for me and for so many others; and Sylvie, Sigal, Tami, Chagit and everyone else who welcomed me into their lives and became my friends along the way—I hope that you will be pleased with the result of my research. To all of the wonderful people involved in the Tapuz surrogacy web forum and to the couples, surrogates, and director, Merav Levy, of the Pundekaut Hoveket [Embracing Surrogacy] agency, I hope you will find this an appropriate representation of the surrogacy experience. Prologue: Yael This work took me into the lives of surrogates and intended mothers alike, forging close anthropologist-informant relationships with each, yet the person who seeped into my consciousness the most was my first informant, Yael, an intended mother. Perhaps this is because she faced so many obstacles on her route to motherhood; perhaps it is because hers was the first surrogacy story I was exposed to. What is clear to me now is that Yael’s story initiated me into the frame of mind necessary to undertake this study—a frame of mind in which I was conscious of the mental, physical, and emotional challenges faced by the women I came to know, both surrogates and intended mothers. I met Yael for our first interview in a coffee shop in Haifa on a Sunday afternoon. I was a newly minted graduate student in anthropology— unmarried, but hoping to become a mother “someday.” She had been married for fifteen years, and her life was completely focused on having her own genetic child, created from an egg harvested from her ovaries and gestated in another woman’s womb. After telling me about the long process she had been through to find a surrogate, she told me about the pregnancy in a whisper that communicated, “If I say it out loud, it might disappear.” Leaning forward, I immediately became a partner in her conspiracy. I, too, whispered each time I mentioned the pregnancy. That first interview began simply. “Tell me your story,” I said, “from wherever it begins.” Instinctively, she began with the day that the army xvii xviii Prologue doctor, on examining her physical health for the mandatory Israeli draft, told her that she had been born without a womb. “Imagine,” she said, “finding out that you could never have children when you were only eighteen years old.” That was the beginning—the day everything changed, the day that her story began. Each of her days since then had been devoted to having a child. “I had planned on going to university,” she told me, “but somehow my life became so wrapped up in having a child that the years just slipped by.” And “it wasn’t easy,” she repeated twice, even though she spoke with a smile. It wasn’t easy at all. Thinking about adoption, choosing surrogacy. The ups and downs of finding the “right” surrogate. The worry, the wait. The changes she and her husband had to incorporate into their lives. “It was strange,” she said, “giving up part of our personal life as a couple and letting a third person in.” Learning to stop living as two, beginning to live life as three. “In some ways,” I suggested, “it was preparation for parenthood.” “But different,” she replied. Tali was the fourth potential surrogate Yael and her husband had proposed to the state committee in charge of approving surrogacy arrangements; the first three women had not been approved for various reasons. Yael recalled the day they met and the joyful day that the pregnancy test was positive. “We didn’t know then what lay ahead,” Yael said. “Now I know not to get excited at least until the first months have passed.” Tali miscarried five months into the first pregnancy. After the miscarriage, another IVF embryo transfer was attempted, and Tali became pregnant with twins. Three months into the pregnancy, the doctors were keeping a close watch to prevent another loss. Yael showed me the ultrasound photos that documented the twins’ existence. She passed the small square photos showing white fuzz on a black background across the table to me. I touched them. Three photos, none of them clear. “Do you see them?” she asked me. I didn’t see a thing. “Wow,” I answered, pretending I did. “I try not to look at them too much,” she told me. “I don’t want to believe it yet. Just in case.” I passed the photos back across the table to her, and she retrieved them with a careful hand. “Are you going to frame those” I asked her, “or put them in an album?” “No,” she answered, “I keep them here,” and she put them back into her bag, in an envelope. I watched the way she inserted the photos into their package. It was like she was putting them to sleep. She held the envelope gently but firmly, securely tucking the photos into her bag. Her babies. They were with her all the time. It occurred to me Prologue xix that she was almost really pregnant. Her babies in a bag, which she carried near her belly. Those little bleeps on the ultrasound monitor. I felt apprehensive calling Yael to find out how the pregnancy was progressing. On the one hand, her experience was data for my study. On the other hand, her life was her own, and I identified with her hopes that this time it would be okay. I crossed my fingers for her. But when I returned to Israel after spending the summer abroad, I found out that Yael’s surrogate had miscarried again. My heart dropped. She had lost the twins. What if a live baby never came? I felt the fear and expectation of the wait. I was pregnant with Yael. Yael was pregnant with her surrogate. I wondered if all of Yael’s friends were pregnant with her, too—in spirit, in heart, in the wait. I called Yael on Rosh Hashanah, the Jewish New Year. We exchanged small talk, but the real conversation occurred beneath the surface of our words. It was the loud silence behind the empty words that I heard most clearly. She felt it as strongly as I did. I could tell because there was a tension on the line that was uncomfortable, even painful. “My heart is with yours,” I told her, and I meant every word. She replied with a simple, but fully aware, “I know.” She did not tell me that Tali was already pregnant again. Two weeks later, she called me to tell me the news. They had just had an ultrasound. It was a boy. In December, I called Yael. She told me that the pregnancy had become complicated. Tali had decided to stop working and stay home. They had run to the hospital a few nights before because Tali was bleeding heavily. “We almost lost the baby. And of all nights, when Miki [Yael’s husband] was in reserve duty and had taken the car. We got to the hospital in a taxi, just in time.” She had taken out her book of Psalms and prayed and prayed, she said. This time it had to work. And then Yael told me that, just that night, Tali, who was of Iraqi heritage, had called her with a craving for a certain type of soup that Moroccans make. Yael’s mother made her a pot, telling Yael that it was like she was making it for her own daughter, because Yael’s son was the one responsible for Tali’s cravings. I came home at nine o’clock one night several months later and listened to my messages on the answering machine. The third message took a minute to register, so I pressed the button and listened to it again. I hadn’t misheard it. It was Yael: “Hi, Elly. Our son was born an hour ago at eleven o’clock this morning. We are here at the hospital. Tali is feeling well. Bye.” I danced around the room and sang a little tune. xx Prologue Some see surrogacy as the ultimate form of exploitation. Others have called it a “brave new world.” For the women I write about in this book, surrogacy is an emotional roller coaster ride in which one mother, through strategy and sacrifice, helps another woman to also become a mother. For the anthropologist, it is about bodies, boundaries, maternities, and meanings. For Yael’s son, who turns ten as this book goes to press, it is the story of how he was born. Introduction In early 2008, surrogacy became the hot topic of the moment, grabbing cover stories in The New York Times and Newsweek.1 Though it would seem that this relatively rare mode of reproduction has become the latest trend in reproduction, it is not new. In fact, the roots of surrogacy can be traced to the book of Genesis.2 Despite the media frenzy that accompanied the heatedly debated Baby M case two decades ago,3 the practice of surrogacy has quietly continued, staying out of the limelight until its recent resurgence in the headlines. Indeed, since the late 1970s, tens of thousands of women have given birth through surrogacy, and an estimated 1,500 babies are born through this practice each year in the United States.4 The practice’s current high profile may perhaps be explained by a slew of celebrities creating families through surrogacy and a surge in surrogacy births in the United States over the past five years.5 As women today increasingly delay childbearing, infertility levels rise, and single persons and same-sex couples pursue more familybuilding options, the use of surrogacy is not just gaining momentum but is likely to increase exponentially. There has been an abundance of interdisciplinary academic inquiry into surrogacy arrangements, generating a complex and nuanced critical debate about the ethical, religious, legal, and broad social issues that these arrangements bring into focus. In general, much of this scholarship has displayed a sense of uneasiness with respect to surrogacy, raising concerns about the commodification of women and children, 1 2 Introduction class and gender-based exploitation of women’s bodies, the distortion of nature, and the devaluing of human life and of women’s reproductive labor.6 Yet, despite the huge attention surrogacy has received in scholarly circles, most explorations of the subject are primarily theoretical and only vaguely based on the actual experiences of those involved in these arrangements: the surrogates and intended parents who come together to bring new humans and new kin relations into the world. Particularly odd, despite the wealth of anthropological attention to many diverse aspects of reproductive technologies,7 is the dearth of ethnographic inquiry into surrogacy. Although the character of surrogacy has evolved over the past decade to privilege the use of gestational surrogacy, no full ethnography of the phenomenon has been attempted since the publication of Helena Ragoné’s study of traditional surrogacy arrangements more than a decade and a half ago.8 Like many of these scholarly conversations, popular accounts of the practice have implied some discomfort with surrogacy, insinuating, for instance, that it might be merely another way for the economically privileged to exploit the lower classes by “renting” poor women’s wombs. This tone of accusation carries over into the current media depictions of celebrities becoming parents with the aid of invisible “gestational carriers” and reports of “outsourcing” surrogacy to India.9 Misrepresented in these generalizations are the majority of women contracting with surrogates; they are not choosing this option lightheartedly because of a fear of stretch marks, nor are they following a fad. When married or heterosexually partnered couples choose to pursue surrogacy, it is usually after long struggles with infertility, pregnancy loss, or other medical conditions.10 For other individuals, such as those for whom the law prevents adoption because they are too old, single, or in a same-sex partnership, surrogacy may provide the only option for becoming parents. The stories behind their decisions to pursue surrogacy and their experiences of the process are far more complex than are implied by one-sided depictions of technological and commercial exploitation. Also left untold in the academic and popular coverage of surrogacy are the stories of the women behind the wombs—the women who have contractually agreed to carry a baby to term. On television, in film, and in popular journalism, they are portrayed in ways that suggest that their decision to voluntarily relinquish a child of their womb to relative strangers in exchange for money can be neatly explained by comparison to the cherished notion of the “good mother.” Indeed, an analysis of the media portrayals suggests an attempt to show that only unnatural or Introduction 3 abnormal women would make this nonnormative choice; surrogates are, in fact, depicted as financially desperate, greedy, emotionally unstable, or overly altruistic to the degree of psychological impairment.11 Women in India who become surrogates are portrayed as desperately poor and in need of rehabilitation, while American military wives who give birth for others are accused of profiting dishonestly at the expense of the military health insurance that covers their surrogate pregnancies.12 The scarce empirical research that exists on surrogacy, primarily psychosocial in nature, also commonly implies surrogates are deviant by hypothesizing their difference from the majority of the population in terms of personality characteristics, morals, and/or psychological history.13 In spite of such a priori assumptions, nearly all of these studies have concluded that surrogates are not markedly different by any measure and that most are within what the researchers consider to be “the normal range” of psychological stability, intelligence, and moral standards.14 There also exists widespread discomfort with the surrogate’s contracted commitment to relinquish the baby, resulting from the belief that the surrogate ought to bond with the baby she carries and that relinquishment therefore ought to be a traumatic event for her. This idea, based on the widespread attention accorded the Baby M case, has little foundation in reality. Indeed, it is estimated that over 99 percent of surrogates have willingly relinquished the child and that less than onetenth of 1 percent of surrogacy cases in the United States end up in court battles.15 The majority of surrogates actually report high satisfaction with the process and report no psychological problems as a result of relinquishment. Longitudinal studies show that these positive attitudes remain stable over time, and most surrogates express their interest in being surrogates again.16 It is here that the work of the anthropologist is needed to think against the grain of what we believe ought to be true. In Birthing a Mother, I am not concerned with making an argument for or against surrogacy or entering into the debate over whether it is right or wrong. Instead, I take a fresh look at surrogacy and attempt to completely rethink what we know about this reproductive practice by taking the experiences of persons immediately involved in it at face value and trying to understand what surrogacy means to them, in their own words. This book is first and foremost an in-depth ethnography of the complex “ontological choreography” of surrogacy arrangements, a metaphor Thompson formulated to describe the “materiality, structural constraint, performativity, discipline, co-dependence of setting and performers, and movement” 4 Introduction involved in assisted reproduction.17 It is also an anthropological intervention into wider debates about motherhood, kinship, embodiment, and the natural. My interpretive approach employs a cross-cultural perspective, contrasting comparative insights with ethnographic data gleaned from an in-depth ethnographic study of surrogacy participants in Israel; as I show, Israel provides an exceptionally advantageous cultural, national, religious, and political context for thinking about these issues. Many different actors are potentially involved in this production; at the very least, it includes doctors, lawyers, intended parents, surrogates, and the state. In addition, an increasing percentage of surrogacy arrangements involve intended parents who are same-sex couples and single persons. The focus of Birthing a Mother is on what still constitutes, in the first decade of the twenty-first century, the majority of surrogacy arrangements, those in which the surrogate is contracted by a married or legally paired heterosexual couple. I analyze the stories surrogates and intended parents tell of the journey they begin from the moment they enter into the world of third-party reproduction and confront the difficult task of making sense of previously taken-for-granted understandings of kinship and maternity. This journey entails navigating an entirely new kind of relationship that creates intimate links between individuals who might otherwise never interact, and it necessitates complex negotiations of personal boundaries and of kin relations. An intricate and delicate balance is required of surrogates and couples as they manage this relationship, which is riddled with risks, miscommunications, and exhilarating moments. My ethnography concentrates on gestational surrogacy arrangements, in which the surrogate conceives using in vitro fertilization (IVF) technology: the egg of the intended mother or of a donor is fertilized in a Petri dish with the sperm of the intended father or of a donor, and the embryo is “implanted” in the surrogate’s uterus. In particular, I explore the avenues through which surrogates and intended mothers navigate the emergent questions they face in relation to motherhood, family, the body, and interpersonal boundaries. I pay particular attention to the social relationship that develops between the two women involved in the process; the intended father’s secondary role is a reflection of his distance from the women’s relationship in most surrogacy arrangements observed in this study. The stakes are high for each of these women in their cooperative but by no means uncomplicated endeavor. Surrogates run the risk of taking part in a process that can easily be constructed as deviant and unnatural Introduction 5 when viewed against the cultural expectation that women should raise the children they bear. An intended mother faces the reality that another woman is carrying her baby; this other woman potentially has a privileged claim to social recognition as the baby’s mother. Both women straddle a delicate position vis-à-vis one another in terms of control: each has reason to feel loss of control during the process, just as each has reason to blame the other party for misusing her power. My study follows surrogates as they continuously abdicate, through language and embodied practice, the title of mother to the babies they carry; they cognitively partition their bodies and “natures” to ensure that their own maternity remains devoted to their own biological children, while the processes of gestation they embody actually facilitate the maternity of their intended mothers. The study also follows intended mothers as they make concentrated efforts to claim the maternal title for themselves and to bridge their embodied distance from the pregnancy by “carrying” the weight of pregnancy-related bureaucracy, constructing pregnant identities, and even embodying the pregnancy vicariously. I draw on in-depth ethnographic fieldwork conducted among gestational surrogates and intended parents in Israel over a period of eight years. The choice of Israel as the location for this study is not incidental. Israel is one of the few countries in the world where surrogacy is legal and where contracts are valid in a court of law. The small geographical size of the country enables research into the hitherto little-explored area of the surrogate–intended mother relationship, as these dyads are able to interact more intensely than surrogacy participants elsewhere, who often live at great distances from one another, for example, in different states in the United States or even different countries. This geographic proximity also affords the anthropologist access to and observation of the often hidden inner workings of the arrangement; even if the same type of emotionally intense relationships do exist elsewhere, it would be impossible for the anthropologist to study them. In the few ethnographic studies to date of surrogacy arrangements, all carried out in the United States, it is no surprise that access to informants was limited to phone and e-mail contacts or that the studies concentrated on only individual surrogate-couple triads.18 Israel is also an eminently suitable context for studying the cultural elements shaping women’s personal experiences of surrogacy because the very concepts being negotiated in these arrangements are amplified in both Jewish religion and in Israeli national discourse. Motherhood, family, and the importance of bearing children have historically been 6 Introduction valorized as having crucial significance for the survival of the Jewish people. Within the context of the Israeli-Palestinian conflict, pronatalist national ideologies and demographic policies have imbued motherhood with major national significance for both sides and have made living childfree by choice an uncommon and socially unacceptable option.19 Jewish women’s bodies, within this context, become a symbolic site in which national and religious boundaries are constituted, particularly because most Orthodox rabbis view birth from a Jewish woman’s womb—whether or not the sperm and egg have come from Jewish genitors—as making the newborn a Jew, and, thus, an Israeli citizen.20 Examining how surrogates and intended mothers negotiate maternity, kin relations, bodies, and boundaries in a context where these stakes are so high amplifies what we might find among surrogacy participants in other cultural contexts. This local version of a global set of surrogacy practices has important implications for the human experience of surrogacy in general. Comparative notes woven throughout the text highlight how the subjectivities that emerge from this local, national, and religious context might emerge differently in other local arenas of the global subculture of surrogacy. Birthing a Mother will be of interest to cultural anthropologists and to scholars and students specializing in medical anthropology, medical sociology, and the anthropology/sociology of reproduction. It also intervenes in wider debates of interest to an interdisciplinary academic audience concerned with issues of gender and sexuality, kinship and family, and science and technology. More broadly, the book provides a comprehensive ethnographic account of surrogacy for policy makers, mental health practitioners, and medical professionals that will enable them to have more informed discussions about surrogacy. It can also be used as a resource for couples and surrogates interested in what makes surrogacy relationships work, as well as for those simply curious to read what really amounts to an insider’s account of surrogacy. Even for those not directly affected by surrogacy, thinking about reproduction in these terms is life altering, as it challenges the way we think about the basic structures of society. The magnitude of change involved in a practice like surrogacy alters our horizon of possibilities and invites contemplation. surrogacy as a cultural anomaly In light of the broad and varied opposition to surrogacy and the controversy it generates, it is no surprise that surveys investigating attitudes Introduction 7 toward the practice in several countries have indicated that the majority of the public disapprove of the practice and perceive surrogacy as the least acceptable of the reproductive technologies.21 This public uneasiness with surrogacy and the stereotypes and misinformation that pervade surrogacy’s public representation are more illustrative of the cultural anxieties that surrogacy encapsulates than of problems with the actual majority of cases. At the base of these anxieties is the subversive nature of surrogacy, which represents a fundamental “cultural anomaly” or incongruity.22 Anomalies are deviations from the natural order or usual method; cultural anomalies emerge when a given culture’s conventions of order and classification are contradicted by an object, person, experience, or event.23 Cultures mark off phenomena that defy classification as anomalies to protect the social structure and moral code.24 Birth, Davis-Floyd argues, is treated as a cultural anomaly in the United States because its unpredictable nature undermines contemporary American beliefs about the superiority of technology over nature.25 Contractual surrogacy, which presents classificatory challenges to two of the most fundamental conceptual structures of modern society— family and motherhood—represents an even more blatantly anomalous phenomenon than birth. In an era when the modern, nuclear family structure is increasingly “fragmented” as divorce rates rise and alternative family forms flourish, surrogacy represents the height of destabilization of the family concept.26 Surrogacy upsets the moral framework in which reproduction is regarded as a “natural fact” grounded in love, marriage, and sexual intercourse.27 Surrogacy constructs families through the marketplace, making them a matter of choice rather than fate. By threatening the understanding of families as biological facts, surrogacy reveals instead that families are social constructs.28 The cultural anxieties provoked by surrogacy in relation to the family are further amplified by the anxieties surrogacy raises over loss of maternal wholeness, as the perceived unity of motherhood is deconstructed in surrogacy and the parts distributed among at least three potential mothers: genetic, gestational, and social. Giving birth to a child for the purpose of relinquishment also defies mainstream assumptions that identify pregnancy with the birth mother’s commitment to the project of subsequent lifelong social mothering and threatens dominant ideologies in many cultures that assume an indissoluble mother-child bond. Directly challenging the “ideology of motherhood,” surrogacy reveals that the belief in motherhood as the natural, desired, and ultimate goal of women in general is also constructed. 8 Introduction In addition, surrogacy disrupts the stability of the concept of nature and the ability of the discourse of the natural to maintain the classificatory categories of motherhood and family discussed above. Nature, social constructivists argue, is a culturally produced category; we need the concept of nature to put order in our thoughts.29 Cultures have employed nature as an idiom to describe what they understand to be the essential principles by which the world is ordered.30 Keeping the concept of nature neatly defined has, therefore, been central to maintaining the power hierarchies of gender and race that are naturalized in many societies31 and to maintaining the idea that technology is superior to nature, which is a basic tenet of technological societies.32 Surrogacy, like other reproductive technologies, disrupts nature’s ability to serve as the ground on which motherhood and family are constituted as “natural facts.”33 Surrogacy thus reveals the fragility of the conceptual system according to which many Western cultures organize themselves. How do surrogates and intended mothers react to being thrust into this boundary-blurring, category-challenging practice? How do they make sense of the surrogacy process? What does surrogacy mean to them? How does surrogacy affect their ongoing articulations of identity? How do they relate to one another during this process? How does each of them relate to the baby? Furthermore, when questions about the identity of the mother and about whose family is being gestated in the surrogate’s womb are constantly in the background, how do the women sort out these dilemmas? How do surrogates preserve their personal identities as mothers—for, in Israel, all surrogates must already have given birth to their own genetic children—while partaking in this potentially deviant role, and how do intended mothers construct a maternal identity? What broader cultural implications do their experiences have for the way we think about gender, motherhood, and family? In this book, I examine these questions as well as the way surrogacy affects how we think about the body. Gestational surrogacy, which is the variant I explore in this study, is facilitated through IVF. When an embryo, formed in a test tube with IVF technology from the egg of the intended mother and the sperm of the intended father (or from anonymous donors), is implanted in the surrogate’s womb, the previously taken-for-granted distinctions between individual bodies is blurred. This transgression of bodily boundaries challenges the once familiar depiction of the body as a whole, interconnected system, complete unto itself with secure bodily boundaries.34 What impact does this challenge have on the way the women involved think about their bodies, especially Introduction 9 about where the boundary of one’s personal body ends and the other woman’s body begins? How does this affect a woman’s sense of individuality and her sense of ownership of her body? What implications does this have for the way we think about the relationship between the body and the self? the cultural politics of surrogate motherhood Because surrogacy does not comfortably fit the cohesive and internally consistent Western system of conceptual categories, many lawmakers have approached it with discomfort. As Rachel Cook, Shelley Day Sclater, and Felicity Kaganas note, “What emerges from any consideration of the ways in which surrogacy is dealt with in different jurisdictions is that a sense of profound anxiety and ambivalence has tended to pervade the thinking of policy makers and legislators where surrogacy is concerned.”35 The most popular strategy has been to treat surrogacy as a deviance that must be censured and as a social problem needing to be strictly regulated or entirely banned. It is prohibited in Islam and in some forms in Catholicism.36 As Markens notes of the ban on the practice in New York in 1992, opposition to surrogacy in the United States has created some “strange bedfellows” among policy makers and special interest groups, including alliances between the Catholic Church and feminist activists.37 In government discussions on surrogacy in many countries and American states, ethical issues have been raised in connection with the commercial nature of the agreement and the potential exploitation of the surrogate. Popular objections to the practice have also been related to Christian ethical concerns over the use of IVF technology and have been tied in with moral debates over fetal rights, cloning, stem cell research, and abortion. Italy’s 2003 law banning surrogacy and restricting the use of other reproductive technologies was influenced by a cross-party alliance between Roman Catholic politicians and the prime minister as well as support from the Vatican, which urged approval of the proposed legislation, saying it protected the rights of unborn children.38 Canada’s Royal Commission on New Reproductive Technologies, headed by Catholic activist Dr. Patricia Baird, rejected all forms of surrogacy arrangements on the grounds that surrogacy commodifies children, exploits women, and is generally harmful to society.39 Even in the United Kingdom, where noncommercial surrogacy was eventually legalized, the British Warnock report concluded that “surrogacy is almost always unethical.”40 10 Introduction As a result of their ambivalence toward surrogacy, the majority of governments around the world have felt justified in banning the practice entirely,41 and those countries that do allow it do not explicitly endorse such contracts, yet permit them to varying degrees. Some governments— Australia (Victoria), Brazil, Hong Kong, Hungary, Israel, the Netherlands, South Africa, and the United Kingdom—enforce partial bans, authorizing court-approved contracts under specific rules and conditions. A small number of jurisdictions allow the practice without state interference, either offering voluntary guidelines (Australia [five states], Korea, and some U.S. states) or avoiding any regulation at all (Belgium, Finland, Greece, and India). As Weisberg has observed, those countries and American states that allow surrogacy agreements do so grudgingly;42 lack of any clear and comprehensive regulatory framework leads to inconsistency and considerable uncertainty in case of disputes.43 The U.S. federal government has not enacted any laws on surrogacy, and the most common response to the issue at the state level is lack of legislation.44 Most surrogacy issues have been determined by state courts and legislations, many responding to specific cases;45 statutory law in states that have a regulatory scheme and case law in states that do not are both piecemeal rather than comprehensive.46 California has held the reputation as the most surrogacy-friendly jurisdiction since a gestational surrogacy agreement was upheld there in 1993 in the Johnson v. Calvert decision.47 The national and international surrogacy markets clustered in California as intended parents from restrictive states and countries sought surrogacy arrangements there.48 Although other states now have similar legal precedents, California still remains the center of the global surrogacy industry today and boasts the highest number of surrogacy agencies and clinics. California surrogacy births— counted in the thousands—far outnumber the mere hundreds of births that take place in the United Kingdom and in Israel; these two countries lead in surrogacy births outside the United States at the present time. Although India has recently become an increasingly popular site for surrogacy-related medical tourism, it is still too early to know whether it will become a major player in the surrogacy market or if legislation will curb the practice.49 The specific ways in which surrogacy is regulated in California, the United Kingdom, and Israel are shaped not only by politics but also by each culture’s key values. The liberal allowance for surrogacy in California extols the core values of individualism, capitalism, and the superiority of technology over nature, all values that have been identi- Introduction 11 fied by Davis-Floyd as central to the American cultural approach to childbirth in general.50 It also speaks to U.S. hesitancy surrounding the issue of state intervention in private reproductive lives.51 In California, an unregulated commercial market of private agencies has prospered since the early 1980s; each agency screens, matches, and regulates agreements according to its own criteria and without state interference.52 Most California agencies extend this option to persons of any age, nationality, marital status, sexual identity, or degree of infertility and also assist with altruistic surrogacy within families. And although traditional surrogacy, whereby the surrogate herself provides the egg, is no longer popular, these agencies continue to offer it as an option. A growing number of American surrogacy agencies now cater specifically to a clientele of same-sex couples and facilitate surrogacy arrangements for intended parents who are single. Most American agencies also work with an international clientele of couples who travel to the United States expressly to pursue surrogacy because it is not legal in their home country, and some agencies specialize in surrogacy tourism from a specific country, such as Japan.53 In contrast to this liberal market model, state regulations in the United Kingdom are mainly intent on keeping surrogacy from becoming a commercial venture by ensuring that no private agencies can profit from the agreements. The U.K. Surrogacy Act of 1985 exhibited the opposition of British national values to American capitalist culture and the perceived threat of commercial surrogacy to British national identity during the last quarter of the twentieth century. Franklin asserts that the negative reaction to surrogacy in the British Parliament was “no doubt in part because it was an American initiative, undertaken during a time of resistance to the Americanization of Britain under Thatcher,” who was attempting to redefine British citizenship through “enterprise culture” and was encouraging privatization of the market, consumerism, and individualism.54 As a result, surrogacy is permitted in the United Kingdom, but contracts are not enforceable, and the third-party profiting of private agencies from commercial surrogacy is explicitly prohibited. The surrogate is legally recognized as the baby’s mother, and her name is written on the birth certificate until the intended parents obtain a court order to transfer custody. The U.K. regulations specifically prohibit payment to the surrogate and encourage intrafamilial and altruistic surrogacy arrangements.55 In actuality, however, U.K. surrogates often receive remuneration, labeled “compensation,” equivalent to the fees paid to U.S. and Israeli surrogates.56 12 Introduction In contrast to California and the United Kingdom, Israel took a markedly different legislative approach to surrogacy. As D. Kelly Weisberg notes in regard to the Israeli surrogacy law, “no other nation or American state goes so far in permitting surrogacy.”57 Passing uncommonly quickly through all legislative channels and accruing support from secular and religious legislators alike, the law, approved on March 7, 1996, regulates compensated surrogacy. A state-appointed approvals committee screens all surrogates and couples according to a centralized set of criteria, and all contracts are signed in the committee’s presence. In general, the committee does not encourage surrogacy and tries to ensure that it remains the last resort for persons who have exhausted all other options to achieve genetic parenthood. Even if all applicants meet the strict criteria of the law, most contracts are only approved after a significant waiting period and much bureaucratic hassle. This type of state intervention in intimate natal issues is not foreign to Israeli demographic policy. The intensity of Israeli state involvement in surrogacy, however, may be more explicit than in other natal issues, for the state is essentially made accountable for each and every surrogacy arrangement carried out on Israeli soil. From a cultural perspective, the influence of Jewish religious ethics made surrogacy a less morally contentious issue in Israel than elsewhere. Instead of being regarded as immoral and tied to abortion politics, as it was in much of the United States and Europe, surrogacy was discussed in Israeli parliamentary debates as a positive solution to infertility, in line with the strong reproductive imperative that has historically characterized the country’s approach to legislation on reproductive technologies.58 In contrast to British policy concerns about commodification, the Israeli surrogacy law does not prevent the surrogate from receiving payment, nor does it preclude the involvement of commercial agencies. Of main concern to Israeli lawmakers was addressing the symbolic threat surrogacy represented to national and religious boundaries. Media coverage and policy debates in the years surrounding its legalization expressed a recurrent concern with the “chaos” that could result if surrogacy were to be practiced locally in a legal vacuum: non-Jewish foreign workers might give birth to babies for Jewish-Israeli couples, or non-Jews from abroad might pay Jewish-Israeli surrogates to gestate their embryos in the Holy Land.59 Judaism is conferred by a Jewish mother through birth; hypothetically, if a non-Jewish woman were Introduction 13 hired to gestate the genetic embryo of a Jewish couple, the child would not be considered Jewish by many Orthodox rabbis because it would not be born from a Jewish woman’s womb.60 This would pose a religious threat to the halachic status of babies born through surrogacy and, metonymically, a threat to the nation’s boundaries. The surrogacy law therefore brings to the forefront clauses that make surrogacy compatible with Jewish law and with the state’s Zionist nationalist ideology. The law strengthens, rather than challenges, national and religious boundaries through regulations ensuring that children born in surrogacy are unequivocally recognized as full-fledged Jews and as Israeli citizens. Surrogacy is permitted only to citizens and permanent residents of Israel, preventing international surrogacy. While the law opens the possibility of surrogacy to all denominations, it requires that parties share the same religion. This precaution was meant to ensure that when Jews entered surrogacy arrangements, their offspring would be considered Jewish. One consequence, however, is that no Muslims and very few Christian Arabs have participated in these arrangements: Islamic prohibitions against surrogacy and strong stigmas surrounding the practice in the Christian-Arab community render it impractical within those groups. To my knowledge, most Israeli surrogacy arrangements to date have been between Jews.61 The law also takes precautions to prevent any infractions of Jewish religious law that might prejudice the “kosher” status of the child. For instance, some rabbis view intrafamilial surrogacy as a form of incest, and the impregnation of a married surrogate by the sperm of a man who is not her husband as a form of adultery.62 Consequently, the law prevents intrafamilial surrogacy and directs that the surrogate cannot be currently married. An additional clause maintains that the intended parents must be man and woman and that the intended father’s sperm be used in fertilization. These precautions were formulated to avoid as many rabbinical objections to surrogacy as possible. These directives also exhibit a conservative approach to the family that stands out against the cultivation of new kinship options and alternative family forms in U.S. surrogacy. Although Israeli policy in general has been liberal toward the use of reproductive technologies by single and lesbian women and has legalized adoption by same-sex couples,63 the surrogacy law prevents these parties from hiring a surrogate by limiting the option only to married or legally paired heterosexual couples. The only families that the law helps to create are heteronormative, 14 Introduction nuclear families, to the exclusion of same-sex couples and single individuals.64 This conservative approach to the family may be a reaction to the potential confusions raised by surrogacy. The law responds to the challenges surrogacy presents to the concepts of motherhood and family by keeping them neatly defined. The law’s terminology deems the couple the “intended parents” and the surrogate the “carrying mother,” specifying that the couple is intended to parent the child and the surrogate is only meant to carry, and thus be an instrument in the nuclear family’s creation. Elsewhere, I have discussed the Israeli surrogacy law from this perspective as “the last outpost of the nuclear family.”65 The Israeli surrogacy law is a fascinating artifact for cultural analysis, and others have provided in-depth accounts of its formulation and its cultural and social context. Weisberg’s sociological account of the “birth” of the Israeli surrogacy law tells the story of the events leading up to its enactment and interprets them using feminist and legal-studies frameworks for discussion,66 while Kahn’s cultural account of reproductive technologies in Israel sheds light on the religious debates that helped shape the law’s guidelines.67 I too have analyzed specific clauses of the law in the context of Zionist-nationalist ideologies.68 Markens’s sociological study of the legislative responses to surrogacy in the states of New York and California sheds light on the common ground of concerns that shape surrogacy as a social problem in different legislative contexts, playing out differently even while employing variations of the same basic discourses of gender, family, race, and motherhood.69 Birthing a Mother focuses on the experiences of the people who are left to navigate the sometimes hazardous shoals of surrogacy within these public discourses and, in particular, under the specific conditions of the Israeli surrogacy law. Significantly, despite the central role that the law and the surrogacy approvals committee play in regulating participation in the contracted agreements, there is little state intervention in the process after the contract has been approved. Committee members are generally not aware of the outcomes of most surrogacies, and no official national statistics related to surrogacy births have yet been compiled. Couples notify a welfare officer of the estimated delivery date during the surrogate’s fifth month of pregnancy, but there is no other contact with state representatives until after the birth. After receiving committee approval, the members of the triad are left on their own to navigate fertility treatments, pregnancy, and their relationships with one another without formal direction or an institutionally provided map. Introduction 15 structures of surrogacy Common to most commercial, gestational surrogacy arrangements, wherever they occur, is the general sequence of events involved. Israeli surrogates and intended parents are sometimes introduced to one another through “matching” agencies that also assist with submission of their file to the surrogacy approvals committee, but these agencies do not usually have any subsequent role in the surrogacy arrangement. Like small agencies in the United States, they may offer support groups for surrogates or aid with referrals to clinics, but they do not employ psychologists or social workers to serve as case managers during the entire process, as some large U.S. agencies do. Still, no matter where couples choose to undergo surrogacy and no matter how their arrangement is facilitated, the general stages of their journey are similar. As their first step, couples search for a surrogate, either through an agency or independently.70 In the majority of commercial surrogacy arrangements, the surrogate is screened for psychological and physical health, although the extent of screening varies. In Israel, where the state centralizes screening criteria, couples submit a file to the approvals committee that includes documents attesting to their and the surrogate’s clean police records, a full medical history, and the results of recent medical tests showing that they are all healthy, disease free, and not substance abusers. An Israeli surrogate also has to be between the ages of twenty-two and thirty-eight, unmarried, and raising at least one child of her own. She will not be approved by the committee if she has had two or more cesarean operations, past miscarriages, or past experiences with toxic pregnancy, low-birth-weight infants (under five pounds) or early deliveries (before the thirty-sixth week). Surrogates can also be rejected if they are obese, if they smoke, or if they have taken antidepressants or undergone gastric bypass or other cosmetic surgeries in the past. In general, the screening process is much less stringent in other locations where surrogacy is practiced. U.S. agencies usually have their own sets of criteria for screening surrogates, some stricter than others; some agencies report that they screen out 90 percent of applicants. In Britain, by way of comparison, where arrangements are not subjected to the screening criteria of commercial agencies or state committees, van den Akker observed that little screening was actually done in the clinics she studied.71 This lack of comprehensive screening might explain how a woman who would have been screened out elsewhere became one of 16 Introduction Britain’s most prolific surrogates. Interviewed in the press after having had babies for seven different couples, she reportedly had no children of her own, took antidepressants through several of her pregnancies, underwent gastric bypass surgery, and attempted suicide following her seventh surrogacy because of anxiety over her weight. Still, she had recently initiated her eighth surrogacy agreement.72 In some U.S. agencies, the intended parents must also meet particular health or social criteria, for instance, relating to infertility or marital status; in Israel, intended parents undergo intensive screening. In addition to being heterosexually paired or legally partnered, they must present convincing medical evidence that the intended mother cannot carry a child to term. The intended mother must provide medical proof that she has tried IVF at least eight to ten times,73 has repeatedly miscarried, or has a convincing medical reason to contract a surrogate such as prolonged infertility, the absence of a uterus, or severe risk to her health. Initially, committee guidelines directed that the intended mother be aged twenty-two to forty-five if providing the ova and twenty-two to fifty-one if using donor eggs, and specified that couples could not apply if they had more than one genetic child prior to surrogacy. Over time, these criteria were challenged by applicants, and the committee now addresses age and family size on a case-by-case basis. The intended father must be able to supply his own sperm. The couple must be able to provide the money for the procedure up front, including the surrogate’s fee of approximately $25,000 and additional costs of approximately $9,000. U.S. surrogates earn roughly $20,000 to $25,000, although second-time surrogates may ask for higher amounts. After the surrogate and couple meet, they sign a contract. This contract may or may not be legally binding, depending on the jurisdiction. Contracts in Israel and elsewhere usually stipulate how much contact the surrogate and couple want to have with one another during the pregnancy and after the birth. Contracts also verify whether the surrogate is willing to undergo prenatal testing, such as amniocentesis, and her willingness to undergo selective reduction or termination if abnormalities in the fetus are detected. The contract includes the schedule of payments, which are usually made in regular installments only after pregnancy is achieved, with the major monetary sum paid after the birth. The contract also states the number of embryo transfers that the surrogate and couple agree to try; in Israel, this is usually six attempts. In the United States, it is often three attempts. Introduction 17 After the contract is signed, treatment begins. In the majority of cases, this stage involves IVF, in which an embryo is formed in a laboratory from the egg and sperm of the intended parents. If fresh embryos are to be used, then the surrogate and intended mother’s menstrual cycles are synchronized: the surrogate receives hormones in pills or injections while the intended mother receives daily injections to hyperstimulate her ovaries so that multiple eggs will mature in one cycle and be ready for extraction when the surrogate’s uterine lining achieves optimum thickness. The intended mother’s ova are then extracted and fertilized through IVF in a Petri dish with the intended father’s sperm, and the resultant embryos are implanted into the surrogate’s uterus within forty-eight hours, or after five days in some cases. In cases in which the intended mother cannot produce viable eggs, donor eggs are used. If frozen embryos are used, only the surrogate’s body is monitored. If conception does not occur, this treatment cycle is repeated the next month. If conception does occur, the surrogate continues to receive hormonal medications for approximately the first twelve weeks of the pregnancy until her body takes over and “natural” pregnancy resumes. In Israel, several attempts are usually made with the intended mother’s eggs before resorting to donor eggs, even if the intended mother is past the age of forty, when chances of conception are lower. Some U.S. surrogacy agencies and fertility clinics advise couples to revert to donor eggs sooner, after only one or two failed attempts with the intended mother’s eggs, because each embryo transfer is more costly in the United States than it is in Israel. If the surrogate does become pregnant, she usually has regular contact by phone, by e-mail, or in person with the intended parents throughout her pregnancy. Most U.S. agencies urge the intended parents to meet with their surrogate several times before the birth, but in most cases, much of the contact between parties is by e-mail and by phone because the sheer distance between areas makes it impractical for the intended parents to meet often with their surrogate; likewise, in cases involving intended parents from other countries whose surrogate is in the U.S., meeting is often nearly impossible. Depending on their geographical distance from one another, surrogates and intended parents can meet for the first time via conference call, at the time of the embryo transfer or even after the surrogate is pregnant. In the majority of U.S. surrogacy arrangements, the intended parents attend the birth; in some cases, they also travel to the surrogate’s location to attend an ultrasound scan in the 18 Introduction second trimester. In some transnational Indian surrogacy arrangements, the surrogate and intended parents do not ever meet; sometimes they even remain completely anonymous throughout the process.74 In Israel, a geographically much smaller country, the parties are usually separated by no more than two hours’ travel. This proximity makes for much more frequent meetings during the pregnancy, and usually, the parents accompany the surrogate to the embryo transfer, most pregnancyrelated medical appointments, and delivery. Israeli surrogates and intended parents, much like their counterparts elsewhere, also have the option of participating in Internet message boards offering information, guidance, and support from other persons involved in the surrogacy process. Surrogacy births, wherever they take place, usually happen in hospitals. In California, the intended parents are given a prebirth order, so that their names are immediately written on the baby’s birth certificate. In the United Kingdom, the baby is recorded under the surrogate’s name, and if she is married, under her husband’s name as well. The intended parents apply for a birth order from the court, and the baby is issued a new birth certificate after the order has been issued. In Israel, the state welfare officer is made official sole guardian of the baby immediately following the birth and for the first weeks of life, until the parents are awarded a birth order in a family court. The intended parents are made temporary custodians of the baby, whom they take home directly from the hospital. Once the baby goes home from the hospital, the shared journey of the surrogate and intended parents comes to an end. It is a journey that begins with a potentially distant, contracted relationship but develops through body-centered interactions into a type of close camaraderie, and it is formulated retrospectively by many surrogates as a heroic quest. My own journey into this world of surrogacy began when I took an unexpected detour, as I relay below. doing fieldwork: a personal note on method I became interested in surrogacy in 1998, soon after the birth of the first Israeli surrogate twins in February of that year. At the time, I was a new graduate student in anthropology working as an interpreter for D. Kelly Weisberg, a visiting law professor at Hebrew University who was researching the events that led to the legalization of surrogacy in Israel—research that culminated in her recent book.75 One day, I accompanied Dr. Weisberg to an interview with the woman I call Yael in this book, who had been central to the passing of the surrogacy law and Introduction 19 who was just beginning the surrogacy process as an intended mother. It was the first time I ever heard the personal story of someone who had struggled with infertility; I had not actually given motherhood, or the challenges some women face in pursuit of motherhood, much thought before that time. I was profoundly touched by Yael’s story and made sure to keep in touch with her after that day. Yael and I became good friends, and my interest in the surrogacy process grew as she shared her personal triumphs and setbacks with me. Until that time, I had thought that I would pursue research related to folk art; due to my relationship with Yael, my focus changed. Because surrogacy was only in its “diaper” stage at that time, locating informants was not a simple task. There had been only four births by the time I began my search for interviewees, and those involved in surrogacy agreements were not part of any formal network. Whereas researchers on the topic in the United States and Britain were able to turn to commercial surrogacy agencies and nonprofit umbrella organizations to access participants for their studies, there was no such option when I began my work.76 This dilemma made collecting anything remotely involved with surrogacy an agenda in itself. I collected every type of legal document connected to the passing of the Israeli surrogacy law available,77 and I also began to collect newspaper articles about surrogacy from the Israeli press.78 I continued to gather these materials throughout the study. One by one, as surrogacy births occurred in Israel, I was able to locate surrogates and intended mothers to interview using a word-of-mouth network. My work reflects how surrogacy arrangements have grown quickly in numbers over the years, growth that facilitated my access to the surrogacy population. To date, I have conducted forty-three formal interviews with twenty-six individual surrogates and forty-five interviews with thirty-five individual intended mothers. Nineteen of the surrogates and twenty-three of the intended mothers were interviewed after the surrogate relinquished the baby. Most of these in-depth, qualitative interviews were done in the interviewees’ homes,79 where I was often able to look at home videos and photo albums, which supplied me with supplementary forms of data. In some of these cases, I interviewed intended mothers and surrogates involved in the same agreement; in the remainder of cases, I interviewed only one of the parties. I was also able to maintain regular contact by phone and in person with a significant number of surrogates and intended mothers throughout most of their surrogacy process and thus learn about their progression 20 Introduction through each stage.80 I also interviewed eight intended fathers and two common-law husbands of surrogates, as well as professionals involved in surrogacy arrangements: four doctors, one lawyer, two psychologists, two agency directors, six social workers, and four approvals committee members.81 In all cases, names and identifying data of informants have been changed. Comparative data on surrogacy in the United States and Britain were primarily gleaned from media coverage, agency brochures, and interviews with the directors of three U.S. surrogacy agencies and with two reproduction lawyers. My access to informants grew after a surrogacy community began to form in 2001 out of the online exchanges of messages between surrogates and intended mothers on a public Internet message board. The members of this forum also meet in person several times a year at one of the members’ homes. I have participated in both the online and faceto-face gatherings of this forum as a participant observer since its inception.82 I was also able to access a much larger number of surrogates after the establishment of a surrogacy agency by one of the intended mothers I had interviewed for my study. I volunteered to help her organize a monthly support group for surrogates through her new agency, and as co-organizer of this support group, I attended all of its meetings from its inception in early 2002 through July 2005.83 Through these venues, I have come to know many surrogates and couples besides those I interviewed for this study. Over time, my involvement in the Israeli surrogacy community has led couples to seek me out as a source of knowledge and advice about the process. They have asked me for referrals to doctors and other professionals involved in surrogacy arrangements and for advice on how to screen potential surrogates and manage surrogacy relationships. After articles appeared in the Israeli press about my research,84 I found myself contacted by rabbis and by social workers at hospitals who needed more information about surrogacy to establish hospital guidelines and by couples who thought I could help them find a surrogate. In a reversal of the ethnographer’s role, after sharing my findings with members of the surrogacy support group and Internet forum, I have encountered surrogates and intended mothers quoting my research in interviews they have given to the popular press and on television. This has led to my work crossing over in some ways into a type of action research, a tradition within public sociology.85 There are no official statistics on surrogacy births in Israel, but my own estimated guess is that approximately 350 children have been born Introduction 21 through these arrangements since the first birth in 1998.86 I would also estimate that, through the various sites of my research, I have met and interacted with, online or in person, two-thirds of the persons involved in Israeli surrogacy arrangements between 1998 and late 2005. In the years following the births of their children, I have maintained contact with many of the persons I interviewed; I have watched some of the children born in these arrangements enter first grade, and I have attended a surrogate’s wedding at which the twins she delivered, then age four, were seated with their parents at the table reserved for the bride’s immediate family. One of the biggest challenges of this research came from dealing with the highly emotional stories I heard. I found myself coming to know these women very well and I became emotionally invested in their stories. My relationship with informants involved straddling a careful line between the intense connections that developed between us during fieldwork and the distance that theoretical analysis entails. I attempted to juggle this precarious position while holding on to my feminist intentions, empathy for informants, and commitment to a balanced ethnographic representation. I conducted most of my fieldwork before I had children of my own, a position that often made surrogates explain things to me in a way they might not have had I been an experienced mother. This positioning also seemed to make me less threatening to the intended mothers; as I describe in part 3, learning of new pregnancies among friends and family while they struggled with infertility was excruciating for many intended mothers. It was only nearing the end of the study, in September 2005, that I became a mother myself. Throughout my pregnancy, I continued to attend monthly support group meetings with surrogates, who were eager to see me become a mother. Nevertheless, I completed all of the interviews with intended mothers by the time my pregnancy was showing, and I did not attend in-person surrogacy forum gatherings while heavy with child out of respect for them. A final word must be paid to terminology. The choice of words with which to write this book was not a simple one. The English term “surrogacy” has been widely discussed as problematic in many ways because it suggests that the surrogate is a substitute or replacement.87 The recent trend toward referring to gestational surrogates as “gestational carriers” is equally problematic, as it implies an instrumental role for the surrogate and trivializes her contribution. My choice of words is further complicated by the fact that I am writing in English about surrogacy practiced among Hebrew speakers. It has therefore been challenging to 22 Introduction construct a terminology that would simultaneously represent the “field” and embody its complexity. In Israel, the popular term to describe the surrogate role is “innkeeper mother” (em pundekait).88 The term pundekait evokes as many political connotations as the word surrogate does, and perhaps more.89 My choice to use the terms “surrogacy,” “gestational surrogacy,” “surrogate,” and “intended parents” was mostly for purposes of clarity, because these terms are the most commonly used in legal and popular texts in English. Moreover, the use of the term “surrogate” instead of “surrogate mother” reflects the women’s belief that the surrogate is not the mother of the child.90 I use the term “intended mother” rather than the term “commissioning mother” to stress that becoming a mother through surrogacy is not just about economics but rather involves many intentional acts. the women of this study One of the questions I am most frequently asked regarding my research is “Who are the surrogates and why are they doing this?”91 In comparison to the data available on participants in surrogacy in the United States, the women in my study differed on several variables. The American surrogate population has been described as predominately non-Hispanic, Protestant whites, working class, with an average age of twenty-seven years.92 In her interviews with surrogates in the late 1980s and early 1990s, Ragoné found that the average American surrogate was married with three children; approximately 30 percent of the surrogates in her study were full-time homemakers.93 Ragoné’s description still seems to accord with the profiles of the “typical surrogate” assembled by many U.S. agencies today; some agencies also claim that up to 50 percent of the surrogates they currently work with are military wives. The Israeli surrogates in this study, by contrast, were significantly older, ranging in age from twenty-three to forty, with an average age of thirty-four.94 Unlike the American surrogates, none of the surrogates in this study were married, although they were all raising at least one child and had an average of 2.54 children. All participants in this study shared the same Jewish religion and Israeli nationality and thus shared cultural knowledge, which might not be the case among international and interdenominational surrogacy pairings. The majority of surrogates and intended parents were born in Israel, but they associated themselves with a wide variety of ethnic heritages and degrees of religious observance.95 Although systematic quan- Introduction 23 titative data on the proportion of particular ethnic identities were not collected for this study, no one group—Eastern European Jews (Ashkenazi) or Jews descended from Muslim-majority countries (Mizrahi)— was numerically dominant in the sample. Couples pursuing surrogacy often came themselves from different ethnic backgrounds, and it was not uncommon for the pairings to present a mix of ethnic heritages, a factor that played a part in the surrogates’ articulation of identity, as I discuss in part 1. It was thus not uncommon to find a Persian intended mother married to a Yemenite man contracting with an Ashkenazi surrogate, or similar cross-ethnic pairings. Geographically, the women in this study were dispersed along the entire length of the country. In terms of education, most of the surrogates did not hold advanced educational degrees, while some, although not the majority, of the intended mothers held bachelor’s or master’s degrees. Intended mothers were between the ages of thirty and fifty-two. Most had steady jobs, whereas many of the surrogates had temporary jobs or did not work. Yet there were exceptions to every rule: I met surrogates who had undergraduate degrees and some who were nurses, teachers, or had higher-paying jobs than their intended mother. Still, most of the surrogates, whether or not they were employed in steady jobs, were struggling as single mothers to support their children. Unlike U.S. surrogates, who can be rejected from surrogacy programs if they are not financially secure or are receiving government assistance, the surrogates I met were usually pursuing surrogacy specifically to supplement their income. Moreover, while some U.S. surrogacy programs reject candidates if they do not have a sufficient support system at home, such as a supportive husband, Israeli surrogates are necessarily unmarried yet raising their children on their own. Finally, U.S. surrogates are screened out of agency programs if their stated motivations are primarily financial. The Israeli surrogates in my study shared many of the same stated motivations as U.S. and British surrogates, such as love of pregnancy, empathy for childless couples, and the desire to make a unique contribution, but they were also unapologetic, honest, and upfront about money being their primary goal in pursuing surrogacy (see also part 3). They expressed diverse economic goals that ranged from the immediate, such as paying off huge debts and providing for their children’s basic needs, to the less immediate, such as saving money for the future. In general, the surrogates in this study fell into three economic classes. The first group (roughly 30 percent) could be described as Israeli middle 24 Introduction class to lower-middle class. Women in this group worked at steady jobs, owned cars, and lived in pleasant homes. They wanted the money to set aside for their children. These women usually lived with boyfriends; they would sometimes tell me that surrogacy was the only way other than winning the lottery that they could earn a substantial amount of money all at once to provide for “extras” for their family. Women in the second group (roughly 50 percent) could be described as Israeli lower class. They worked at odd jobs such as house cleaning and most of them lived on welfare stipends or government aid of some sort. They wanted the money to give them a financial “push” forward in life, and especially to enable them to move to a better apartment or to pay off debts. This category includes surrogates who lived in government housing and even one who lived in a three-room caravan, but inside their homes they had food, clothed children, and electronic appliances including VCRs, DVD players and computers. The third group (roughly 20 percent) lived in very run-down apartments in low-income areas and could be described as very poor. These women desperately needed the money they earned as surrogates. They sometimes mentioned that surrogacy was a better option for resolving their situation than other options they had considered, such as selling a kidney. The percentage of this group has declined over the years of my research because the approvals committee is hesitant to approve women who are in such severe financial situations.96 Economic and class differences exist between surrogates and couples in Israel, but they are smaller than those between U.S. surrogates and couples. Surrogacy has been an option available primarily to the wealthy in the United States, where agency fees, surrogate fees, private medical insurance, and the costs of each IVF attempt in gestational surrogacy (between $5,000 and $20,000) mean that the total costs range from $50,000 for an independent surrogacy to $120,000 for an agency-arbitrated arrangement that includes private health insurance for the surrogate.97 This does not mean that all intended parents approaching surrogacy in the United States are wealthy; indeed, in a significant number of American surrogacy agreements, a friend or relative of the intended parents offers to be their surrogate without compensation, and in some cases the intended parents’ medical insurance helps to offset some of the costs of the fertility treatments. However, for the majority of cases in which these costs are relevant, surrogacy is scarcely affordable to the middle class. This is not necessarily the case in Israel, because Israeli national health insurance offsets the costs by financing medical care and fertility Introduction 25 treatments, so that Israeli couples pay significantly less out of pocket. Their major expenses are the surrogate’s fee (roughly $25,000); the extra costs required by the committee, which are partially refunded if not used (roughly $9,000); the costs of the psychological screening (roughly $1,800); and the agency fee, if one is used (roughly $8,000). As a result, instead of being reserved for the economically privileged, commercial surrogacy is more readily available to Israel’s middle class. No more than five couples I met could be characterized as wealthy; most had found creative ways to pay for surrogacy, including receiving loans from wealthy friends, using their parents’ life savings, taking out a special “surrogacy mortgage” from a mortgage bank, selling their car, selling their house and renting a smaller apartment, or living with their own parents during surrogacy to save on expenses. overview of BIRTHING A MOTHER The chapters that follow address the personal experiences of surrogates and intended mothers both individually and through their relationships. Part 1, “Dividing,” looks at the ways that surrogates experience the process. In it, I examine the ways surrogates negotiate the meanings of nature, motherhood, and family by inscribing symbolic lines of demarcation on their bodies, thereby producing a body map. Through this body map, they distinguish between parts of the body they wish to personalize and parts they wish to distance, both cognitively and emotionally. On the basis of their body maps, the women conceptually divide their bodies into different parts that they view as varyingly detached or connected to their own body and to their intended mother’s body. Surrogates use the body map to form an interlinked, networked connection with their intended mother for the duration of the pregnancy. They also employ the body map as a tool during the pregnancy to conduct distancing “emotion work” from the fetus and to manage interpersonal boundaries between themselves and their couples. Part 2, “Connecting,” concentrates on the intended mother and on the surrogate–intended mother relationship. Intended mothers engage in various “claiming practices” to establish their role, status, and identity as mother and to claim ownership of the fetus that the surrogate gestates. Surrogates and intended mothers also engage in joint practices to symbolically remove the pregnancy from the surrogate’s body and append it to the intended mother. This leads me to a discussion of the intended mother’s resultant manifestation of a “pregnant identity” 26 Introduction and her own body’s response to the pregnancy. Conceptualizing this as a shifting body, I look at the ways in which this shifting of pregnant embodiment, experience, and identity is supported and co-constructed by the medical system and the women’s significant others. In some cases, women describe the intensity of this bodily connection in terms of interchangeability, marriage, or merging into unity. Part 3, “Separating,” examines the postbirth period. In this stage, the medical system and the state emerge after the surrogate delivers the baby to ritually separate the women. The intended mother’s own postnatal incorporation of her new role, identity, and status as mother is also explored. This public and private promotion of separation between the surrogate and intended mother is counterpoised with the surrogate’s differing expectations regarding the aftermath of the surrogacy agreement. The surrogate’s desire for acknowledgment beyond the monetary payment is related to her understanding of the relationship in gifting terms.98 The future of the women’s ongoing relationship, or lack thereof, is contingent on the intended mother’s adoption of the surrogate’s gifting logic or her refusal to acknowledge the obligations that receiving the surrogate’s gift entails. Part 4, “Redefining,” looks at the way surrogates formulate their surrogacy journey as a quest or odyssey that leads them to acquire self-definition and self-knowledge. I discuss this heroic framing of the surrogate role against the backdrop of the many constraints and potentially disempowering elements that are part of the structure of the surrogacy process as a whole, particularly in Israel. I propose several explanations for the apparent paradox between the restrictive circumstances of the surrogacy process and the women’s experience of empowerment. In the conclusion, I offer a more in-depth discussion of the links between the women’s narrated experiences and Israeli nationalism, Jewish religion, and the type of civic maternalism particular to Jewish-Israeli culture. I then look at the ways the ethnography reflects on some of the main theoretical concerns surrounding surrogacy and on the implications for state control of reproduction more widely. Finally, I suggest ways in which the data that emerge from this study might contribute to more informed public policies on surrogacy around the world. part on e Dividing This page intentionally left blank the dominant ideologies surrounding maternity in many countries focus on the “natural” role of women as mothers with special bonds to the children they bear.1 Through their contractual relationships with childless couples, for whom they carry children to term in exchange for payment, surrogates risk doing something popularly believed to be “against their maternal nature” and a violation of the natural order. With this in mind, psychosocial studies have hypothesized that women who choose to become surrogates may be nontraditional thinkers or somehow different from the majority of the population.2 However, most studies have found that surrogates subscribe to conventional beliefs about sex roles and motherhood and believe ardently in the conservative values of having children and being good wives and mothers.3 Reconciling their role in surrogacy with their self-perception as “good mothers” to their own children was also at the forefront of concern for the women in this study, much as Ragoné found in her study of U.S. surrogates.4 The great weight that preserving the reputation of their own motherhood carried for the Israeli surrogates I encountered may also be attributable to the amplified cultural veneration of motherhood in the Jewish religion and to the pronatalist ideology of the state. Some writers have suggested that Israeli women participate in what has been described as a “cult of fertility,” in which reproduction is, and historically has been, constructed as the Jewish-Israeli woman’s “national mission.”5 In this cultural climate, in which being childfree by choice is not socially accepted and reproductive technologies are widely available and nationally subsidized for the infertile, surrogacy becomes an especially explosive terrain to navigate. In relinquishing the babies they bore to others, the surrogates in this study risked being seen as engaging in “unnatural” or deviant behavior and also as violating their gendered national duty and expected cultural role.6 In this section, I explore the surrogates’ attempts to ensure that their actions do not negatively affect their personal, social, and national identities. I pay particular attention to the rhetorical and embodied strategies that surrogates use both to maintain distinctions between the traditional concepts of motherhood, family, and nature and to preserve 30 Part One: Dividing interpersonal boundaries. Chapter 1 concentrates on the way surrogates interpret conceptive technologies and their own pregnancy symptoms using an idiom of “nature” to distinguish between that which is personal and that which is foreign to their bodies. Chapter 2 focuses on the lines of demarcation—the body map—that surrogates inscribe on their bodies to define whose kin, motherhood, and nature are being cultivated during surrogacy. Surrogates engage in cognitive and bodily distancing practices that help them maintain these separations. Chapter 3 explores how the body map aids them in their attempts to distance themselves from the fetus and protect themselves from being “suffocated” by the contracting couple. The operationalization of this “mapping” serves as a crucial tool in helping the surrogate manage within the limiting structure of the surrogacy contract. The body map enables surrogates not only to endure what could otherwise be an extremely subjugating experience but also to manifest personal agency in constrained circumstances. I want to clarify at the outset that my exploration of surrogates’ lifeworlds does not address their personality characteristics or motivations for surrogacy. Indeed, I view the attempt to characterize surrogates as somehow different from the general population, measurable by particular personality traits or moral shortcomings, as insinuating that these women are maternally deviant.7 My point of departure is to take at face value the findings of study after study that surrogates are primarily “intelligent, self-aware, stable adults” who are “down to earth, practical, decent people.”8 Moreover, I do not assume that most surrogates are regretful or remorseful about relinquishment or that they feel exploited by the process. Following Lomsky-Feder’s approach to researching the personal narratives of war veterans and Sharp’s approach to the study of transplant recipients,9 I view the underlying assumption that surrogacy is necessarily traumatic for surrogates as eclipsing the meaning of the process for surrogates themselves. It is only by moving beyond preconceived ideas that we can begin to listen to the way that surrogates articulate their experiences and uncover the personal meaning of surrogacy for them. chapter 1 Surrogate Selves and Embodied Others There are a number of metaphors that I observed surrogates using to describe their bodies during the process. These metaphors could easily be considered most feminists’ worst nightmare: woman as technovessel, implanted with the seed of the patriarchy and lacking control over her body, which is nothing more than a vehicle serving wider systems. They could also be interpreted as mere reflections of the mind/body separation that goes hand-in-hand with the body-as-machine metaphor that is so central to the mechanical model of pregnancy and birth in postindustrial, capitalist societies.1 However, paradoxically, these kinds of images were often conjured up by surrogates in the context of rebutting ideas suggested in radical feminists’ critiques and as assertions of agency and autonomy. During a conversation with Neta, thirty-three years old and the mother of one when she gave birth to her couple’s baby, I was surprised to hear her express anger at “those feminists” who critique surrogacy as reducing women to “mother machines” and then refer to herself through a mechanical metaphor: What do they think? That we are robots with no feelings? . . . I am here in order to help. . . . I don’t even call it a womb for rent. I call myself an oven. . . . An oven that bakes the bread for hungry people. I just help them. . . . Like if my friend needed a loan, I would save from my own food, and I would give her a loan. Would they then say that I am being used? What idiocy that is. 31 32 Part One: Dividing Why did Neta call herself an oven? The explicit self-objectification of the body that the metaphor expressed was alarming to me, especially when many radical feminist opponents of surrogacy employ similar metaphors to argue that reproductive technologies exploit women. These authors use technological images to describe surrogacy as reducing women to “uterine environments,” “living laboratories,” “test-tube women,” “mother-machines,” “fetal containers,” and “vessels.” In addition, they draw from agricultural images to compare women to “fields” for men’s “seed,” “breeders,” “stables of reproductive whores,” and “women-as-cows” on patriarchal “factory farms.”2 It struck me as contradictory for Neta to reject being called a robot while at the same time asserting that she was another kind of mechanical instrument. Two years later, I spoke alongside Neta at a national conference of IVF doctors. There, in front of a large audience, Neta again responded to a question about surrogates as victims by firmly stating that she was not a victim but “the oven that bakes the bread of hungry people.” While I was still puzzling over what Neta was trying to express through this metaphor, I interviewed Shahar, thirty-two, who was already a mother of five when she gave birth to twins for her couple. While narrating her experience, Shahar applied another seemingly dehumanizing metaphor: I am only carrying the issue, I don’t have any part in the issue. . . . I mean, I gave them life, because without me they would not have life. Because [the intended mother] couldn’t carry them. Only someone with a womb, a good womb, could hold the children for her. So I am the one. . . . I just held them in my belly, like an incubator. I was their incubator for nine months! . . . And the second that they were born, I finished the job and that was it. Like Neta’s oven metaphor, the image of the incubator connotes the technological colonization of women’s bodies. Some radical feminist opponents of reproductive technology, such as Raymond, have pointed to the example of U.S. surrogates describing themselves as incubators as evidence of how far women using these technologies internalize patriarchal views of their bodies.3 Overall has interpreted surrogates’ use of the incubator image as a sign that surrogacy is an extreme form of alienated labor that negates the surrogate as a person (see figure 1).4 If ovens and incubators are both machines, could these women be using such metaphors to express the idea that they are technological instruments—mother machines—during surrogacy? If so, then, why did Batya draw on images from the world of plants, rather than machines, Surrogate Selves and Embodied Others 33 Figure 1. Illustration depicting a surrogate attached to an incubator. Originally appeared in Haaretz newspaper. Reproduced with the permission of the artist, Ruth Gwily. to describe her body during surrogacy? Aged thirty-one and a mother of five, Batya arrived at our interview with her sister-in-law, who actively participated in our meeting. When I asked Batya if she would ever donate an egg, she immediately answered, “Never!” and then went on to explain why she saw egg donation as completely different from gestational surrogacy: Batya: There’s a difference! It [the egg] is mine! It is created from me!!! Here [in surrogacy] it is not created from me! It is his egg and sperm . . . Sister-in-law (interrupting her): She is just storing it [me’achsenet] . . . Batya: Yes! . . . I am just like a hothouse [hamama]! Sister-in-law: Like a refrigerator. Like a wrapper. Batya describes her womb as a hamama—a hothouse or a greenhouse in which plants are grown in conditions of controlled temperature, irrigation, and sunlight. Like the oven and incubator metaphors, the “seed and the soil” have had their fair share of attention as images linked to 34 Part One: Dividing Figure 2. Illustration depicting a surrogate holding a flowerpot for the couple’s sapling. Originally appeared in Yedioth Aharonot newspaper. Reproduced with the permission of the artist, David Polonsky. the patriarchal control of women’s bodies.5 Batya’s use of this imagery could thus be understood as reflecting the influence of patriarchal kinship ideas on her thinking: perhaps she is implying that she sees herself as the soil in which men’s seeds grow, as Rothman’s work might suggest (see figure 2).6 But what can we make of Batya’s correction of her sisterin-law, who described her as a wrapper and a refrigerator versus her assertion that she is a hothouse? Surrogate Selves and Embodied Others 35 Figure 3. Photo of a mug sold by a three-time surrogate mother on her website, depicting an oven and the popular slogan “Their bun, my oven.” Reproduced with the permission of the artist, Meg Kampel (http://www .megscustomcreations.com). surrogate metaphors and meanings The specific set of metaphors described above share similarities with those prevalent among U.S. surrogates.7 Indeed, the slogan “their bun, my oven,” has become so commonplace among American surrogates that it appears on products sold online, such as T-shirts and license plates (see figure 3). Israeli surrogates I spoke with also used variations of this idea, speaking of “an oven baking a cake” and “a kiln baking a sculpture.” Yet U.S. surrogates also used a variety of other metaphors, such as “gardens,” “cows,” and “baby machines,”8 that were rarely used among Israeli surrogates. Following the many studies that have revealed the world of meanings encompassed by metaphors in reproduction narratives,9 I decided to try 36 Part One: Dividing to decipher what these metaphors alluded to beyond their patriarchal surface connotations and what the slight differences in imagery might reveal. Kirmayer notes that metaphors are microcosms of meaning that relate to the larger context of a narrative.10 They also extend the scope of expression of the narrative and open up new paths for exploring it by gesturing toward other stories that may not be overtly taken up by the narrative.11 I suggest that underlying the dominant surrogate metaphors of baby incubator, hothouse, and oven is a conceptualization of the body during surrogacy as a complex map of nature and culture (technology), depicting parts that can be integrated or detached. Whereas a garden and a cow can be solely ascribed to the natural realm and the “baby machine” to the technological one, the way dominant metaphors are used reveals that the linkages between these two realms are important to how Israeli surrogates envision their bodies and roles. All of these metaphors designate the surrogate’s womb as an artificial, containing environment in which the couple’s “nature” is nurtured to viability in a controlled, warm temperature, as in a baby incubator, hothouse, or oven. The metaphors suggest that the couple’s nature has been formed even before entering the surrogate’s body: the couple’s baby, sprouted sapling, and kneaded dough originate in the couple’s egg and sperm, but additional processing is needed to produce their final form as infant, plant, and bread. Surrogates therefore are implying that they do not create the fetus in any way but develop an already prepared fetus to viability. Eva, who gave birth to twins for her couple, said this explicitly: “I took them [the twins] when they were small, fed them and helped them grow, and then sent them home.” The metaphors thus encapsulate the general conceptual scheme that surrogates apply to their bodies in surrogacy: each surrogate sees her body as a complex puzzle, constituted by the coexistence of her personal nature, the artificial womb she embodies, and the couple’s nature that she gestates inside it. In a particularly clever twist on the nature/culture/other nature amalgamation, Batya’s hothouse metaphor implies she is an artificial environment that simulates the natural habitat in which precious, valuable, expensive, and cultivated plants grow. Shahar’s incubator metaphor draws on a device that is routinely used in hospitals to temporarily replace and simulate the pregnant mother’s “natural” womb. Incubators are used in the IVF process to keep the embryo alive before it is implanted in the woman’s uterus, and, in the world of premature babies, an incubator’s task is to “artificially gestate to maturity” a baby born Surrogate Selves and Embodied Others 37 before thirty-eight weeks’ gestation.12 Consequently, Shahar’s incubator metaphor positions her on a continuum of artificial environments used to simulate the “natural” womb without threatening the “natural” mother’s claim as the only mother of the child.13 In addition, all three metaphors encapsulate a tension between external control and personal agency. Specifically, it is not the surrogate herself who turns on the oven or who places the plant or baby in the artificial environment, which suggests that she is controlled by the baker/gardener/doctor. The idea that the pregnancy is “switched on” and controlled externally enables the surrogate to emphasize its nonnaturalness but does not negate her view of herself as the most essential person in the process. In this light, Shahar asserted that she was an incubator because she “gave them life, because without me they would not have life,” that is, the twins she bore would not have been born without her warm, embodied, artificial life-support system.14 Her use of the word “them” leaves the question of to whom she “gave life” open to interpretation: the twins she bore or the couple for whom she bore them. The metaphors thus encapsulate the complex power structure of surrogacy: the surrogate may be structurally constrained and, as popular portrayals of surrogates in the media have highlighted, she may have become a surrogate to “feed [her] children,”15 but she sees herself as powerful. Neta’s use of the oven metaphor vividly evokes this power, for she is feeding not only her own child and the fetus, but also the “hungry” couple, helping them by baking the bread that they would not otherwise have. Their hunger, as a classic signifier of powerlessness,16 is positioned in opposition to her power to feed, upturning any connotations that the couple is more powerful than she in the relationship. Finally, we might understand the metaphors as each affirming that bringing the fetus to viability depends on the surrogate’s own nurturing, warming capabilities. An oven, an incubator, and a hothouse are all necessarily warm environments, in contrast to the cold, distant connotations of a “mother machine.” Each apparatus maintains a constant, controlled temperature that is needed to warm the couple’s nature to viability. Batya’s assertion that she was a warm hothouse, as opposed to her sister-in-law’s description of her as a cold refrigerator or a neutral wrapper, highlights the centrality of warmth in the women’s imagery. Roberts points out that technology is usually assumed to be cold but that it ironically “warms up” the process of surrogacy by creating connections between the parties involved through the hormonal 38 Part One: Dividing synchronization of the two women’s bodies, the ultrasound, and labor induction.17 Tempering Roberts’s claim, I would suggest that, through the metaphors they use, surrogates assert that it is not technology that is warming up surrogacy but they themselves: they warm up their artificial womb simulators to provide the warmth assumed to be necessary for gestation. Technology cannot produce the comfort that the surrogate can, as Yana expressed several weeks after birthing her couple’s child: “I just gave him [the baby] a warm and comfortable place to be, so that he would be happy to enter this world.” This is a human warmth that emanates from the surrogate’s heart, rather than something “artificial.” As Tamar told me when she was seven months pregnant with her couple’s child, “It isn’t a womb for rent . . . it isn’t quick money and finished.” Instead, she asserted, “It is a warm place, both in the belly and in the heart. . . . We surrogates prepare this fetus, feed [it], give him life. We need to develop what is inserted into us until it is ready.” To sum up, if “culture” is the cold, instrumental hand of medical technology and “nature” is the warm, nurturing womb, then surrogates are using culture to simulate nature as they artificially incubate other nature in an artificial womb. partitioning nature and the artificial body Central to most of the surrogates’ narratives was the belief in an allpowerful nature that makes conception occur (through sexual intercourse) and fosters an instinctive emotional attachment between women and their “natural” babies. Idit, thirty-two years old and the mother of two, told me that during surrogacy she “didn’t feel an emotional connection” with the fetus as she had during her pregnancies with her own children, when she had “felt joy with every development.” Explaining this difference in terms of nature, she said, “Nature created it in a woman . . . the woman’s attachment [to the fetus] is a part of the process of biological pregnancy. . . . It cannot be explained.” Idit’s idea of nature encompasses women universally in biogenetic pregnancy, as she established by referring to my own potential future motherhood and to the commonality of innate emotions that I, too, as a woman in nature, would hypothetically develop in pregnancy. Yet she believed that this force does not uncontrollably spring forth from “deep inside” the “body and soul” of a woman when the pregnancy is “artificial”: Surrogate Selves and Embodied Others 39 Nature and the body make sure that the work is done. From the moment that it is your own egg, then automatically the woman feels that it is her pregnancy. Even if she doesn’t want it, and even if she miscarries, she will feel that it is her child, deep inside, in her soul. I hope that you will be a mother one day, and you will feel it, because it is hard not to feel that feeling. Also, when the mother gives birth, how does she receive the baby? Naturally! In a natural way. So that way, in the same natural and biological way, the mother feels toward the fetus. [But here] . . . it is all artificial! Everything is artificial . . . so what is there to become attached to? Technologically assisted conception, to Idit, is far from natural. She describes it using the Hebrew word m’lachuti, meaning artificial, simulated, unnatural, and man-made. By aligning the IVF conception process with artifice, Idit stresses its departure from the nature she has described; to her, the technology is a substitute, copy, or simulation of a natural process: It [conception] was done in an artificial way. . . . First of all . . . the conception itself. It isn’t biological. The fetus in the womb isn’t aware of this during the pregnancy, but the initial development of the pregnancy was different from a regular pregnancy. When the pregnancy is regular, you get pregnant by your [male] partner and it unites [the sperm and egg] in a natural way. Here, the pregnancy isn’t mine. It’s from other genes . . . from him and from her . . . and you use artificial hormones to keep the pregnancy. Like Idit, all of the surrogates that I spoke to aligned ideas about nature and artifice with a conservative cultural script about the way maternal emotions operate. They all believed that women have an innate love for their own children when those children “come . . . from nature,” as one surrogate put it. This attachment was considered part of every woman’s “biology” and related to the way female “hormones” work. Nearly all of the women contrasted the strong emotional attachment they felt to their own children prenatally to their emotional distance from the surrogate child. The intensity of their comparisons between their own gestations and surrogacy hints at “an internal sense of transgression”18 that surrogates may experience upon realizing that their emotional distance from the fetus might be publicly interpreted as a sign of deviance. Surrogates routinely told me about comments to which they were subjected on a daily basis. For instance, Shiri noted, “People are so ignorant. They look at you like you are doing something bad when you tell them. They ask, how can you give away your children? This [points to belly] is not my child!” 40 Part One: Dividing Surrogates endowed the technology involved in the conception process with the power to undo the natural tendencies they believed bond them with the children they carry. Idit emphasizes that the technology facilitates her distance from the fetus: “The technology today is so advanced . . . you even see the embryo on the ultrasound the day that they implant you with it and you see that it isn’t yours.” The technology makes her separation from the fetus certain, logical, visually recognizable, and convincing, enabling her to assert, without hesitation, that as a logical outcome of the conception process she felt no attachment to the fetus throughout the pregnancy: “In a pregnancy, when it is yours, you will feel maternal intuition and feel somehow that it is yours, and here I didn’t have that.” The fertility treatment that the surrogate undergoes to prepare her body for the embryo transfer paves the way for the perception that technology overrides nature.19 First, the surrogate receives injections or pills of synthetic hormones to synchronize her menstrual cycle with the intended mother’s cycle and to prepare her uterus. Next, she undergoes blood tests and ultrasound scans to monitor her hormone levels and uterine lining thickness. After the couple’s embryo is implanted in her uterus, she receives additional hormonal supplements through injections or suppositories up through the twelfth week of gestation to maintain the pregnancy until her body “takes over.”20 Sima, age thirtyfour, who gave birth to surrogate twins between the births of her first two children, explained how this process subdued her body’s personal nature but did not erase it entirely: You get ten days of injections, every day, in order to suppress your . . . biological system. To suppress it and prepare your womb for absorption of something else, [something] strange, in an artificial way. Sima delineates the hierarchical relations she embodies: technology suppresses her “biological system,” holding her nature dormant so that culture (technology) can command her body. Like Sima, Orna, who was thirty-six and a mother of three when she became a surrogate, endows the hormone treatment with a powerful, external agency that has the power to draw a virtual line through the body, circumscribing a woman’s nature beneath her body’s surface and preserving it like a sacred, untouchable substance until after the pregnancy. Orna claimed that the technological takeover of her body was so complete that her brain didn’t even register the pregnancy: Surrogate Selves and Embodied Others 41 It is not mine. It is all artificial. . . . The hormones do it all instead of me. My brain doesn’t even know that I am pregnant. My brain is suppressed with the shots that they give me. It turns my brain back to zero. Then all that is needed is given through pills. Through hormones . . . the brain is the injections. Instead of the brain ordering one, two, three, the hormones need to go up, need to go down, and then the injections do everything. In these comments, Orna clearly outlines set relations among parts of the body, delineating which parts “know” that she is pregnant and which parts—such as her suppressed and zero-calibrated “brain”—are unaware of the hormonal “takeover.” In a radio interview, Orna further explained that the treatment she received to prepare her body for surrogacy was intended to “neutralize the body,” and “then the doctor starts to give the body hormones, to give order to the body. To neutralize everything and to prepare the body to receive the embryo.”21 Orna’s perception of the conception process reads as that of a woman willingly relinquishing command of her body to a medical professional and to medical technology. From one perspective, her words are an extreme example of the social consequences of reproductive technologies most feared by feminist scholars: total male, medical, institutional control of women’s bodies and of “natural” childbirth. Yet as ethnographic studies of women’s encounters with reproductive technologies have established, individual women may use these technologies in pragmatic ways and even engage in self-objectification and self-medicalization as a form of agency.22 Accordingly, Orna embraces the potential of external medical control of her body to maintain clear separation between the categories of nature and artifice. recognizing the artificial body The surrogates I spoke to saw the entire pregnancy as “unnatural.” Rinat, a thirty-eight-year-old mother of five when she became a surrogate, promptly became pregnant with her sixth child after birthing a son for her couple. Comparing her body during surrogacy to her body during her own pregnancies, Rinat asserted: It isn’t normal. You have to take their hormones, because the hormones aren’t yours. And you start to get bloated. . . . In the beginning, I got a bit round. . . . And I am usually very small in my pregnancies! . . . But here [pointing to a photo of herself pregnant, with her arm around the intended mother] I weighed 70-something kilos [154 pounds] from the injections 42 Part One: Dividing and the hormones that they gave me. . . . Suddenly I got a bottom, I got a tummy, I got thighs . . . from the hormones. The hormones change your body. And my hair fell out . . . because of the hormones. They aren’t yours. The hormones that enter your body are strangers. They give them to you in injections. It is hormones for the baby to develop well. . . . They give them to you for a month and a half and that’s it. But afterwards, it affects the pregnancy until after the birth. Rinat views the hormones as “strangers” entering her body from outside and disrupting the “normal” and routine way it had behaved during her own pregnancies. She believed that the hormones made signs of her body’s naturalness fall away: her hair fell out in bunches, and her belly and bottom grew round. Like Orna’s description of her brain being selectively taken over by the hormones during treatment, Rinat’s idea of her belly, bottom, and hair being overpowered by the hormones shows that the imaginary dividing line that separates nature and artifice in the surrogate’s body can be selectively mapped onto different parts. Just as she suggested that the “unnatural” beginnings of the pregnancy “affect the pregnancy until after the birth,” Rinat described the birth of the surrogate child as strange and miraculously different from the birth of her own children: Suddenly I go to bed, lay in bed, and I have labor pains. In my own births, I don’t have labor pains . . . not in the births of any of my children. . . . Suddenly I felt these pains. . . . If I ever have labor pains, I get them in my back. And these didn’t come in my back. Here, I really felt pains in my belly. Women’s descriptions of their bodies during surrogacy almost always included examples of how the body responded differently to artificial pregnancy than it had to “natural” conceptions. Ravit reported that “this pregnancy is making me experience all sorts of strange and unexpected things with my body.” Since surrogates had previously experienced, on average, 2.54 pregnancies, they were certain they “knew” how their bodies “normally” reacted to pregnancy. They so often compared three models of the body in their narratives—the natural everyday body, the natural pregnant body, and the artificial surrogate body—that I ended up incorporating the comparisons into my interview questions. For some of the women, the artificial surrogate body acted oppositely from the natural pregnant body. Sapir claimed that when she was pregnant with her son, she “was always sleepy. I would wake up like a prima donna, feeling faint. My mom would wake me up around 11, and I would go into the living room and continue to sleep until 12.” She Surrogate Selves and Embodied Others 43 compared this prenatal lethargy to the insomnia she experienced during surrogacy: “I couldn’t sleep at night, so all night I would be awake and during the day I would sleep, and my whole daily schedule was turned upside down.” Some women felt uncharacteristically good physically during surrogacy. Idit, who had birthed two children and had terminated several additional pregnancies, said that during surrogacy she felt “healthier than in any of the other pregnancies. . . . No swelling, not anything. [In my pregnancies] there were more problems than in this pregnancy.” Batya found that her surrogate pregnancy, after five pregnancies of her own, was the least symptomatic and the most comfortable. She explained that “in my pregnancies . . . I have fainting spells. Here, I didn’t have any! . . . Actually, in this pregnancy, I just bloomed, really!” For the majority of women, however, the “artificial” body caused unexpected suffering. Tamar pointed out that when she was pregnant with her daughter she “was active, energetic,” whereas during surrogacy, “I had no strength, I felt heavy and ugly and fat.” Moreover, during her daughter’s gestation, she “only gained 12 kilos [26 pounds], and I didn’t vomit at all, but in [her intended mother] Miri’s pregnancy, I vomited and gained 20 kilos [44 pounds]. In the end, I weighed 86 kilos [189 pounds]! It’s also from the hormones, because they aren’t natural. So physically, this pregnancy was completely different than the pregnancy with [my daughter].” Like Tamar, many of the women contrasted their suffering during surrogacy to the relative ease and uncomplicated nature of their previous pregnancies. In fact, in line with their U.S. cohort,23 one of the reasons they had chosen to become surrogates was their previous experience of easy pregnancies and uncomplicated deliveries, and it was on the basis of their generally good health that they had passed the stringent medical screening of the surrogacy approvals committee. The surrogates referred to details of these previous pregnancies to highlight the unanticipated behavior of the artificial body in surrogacy. Some said they would not have chosen to become surrogates if they had known it would be so physically difficult. Neta claimed that she was “not a sickly type,” so she was surprised to discover that during surrogacy she “was very ill that winter. I was ill around three times. With antibiotics.” Belle experienced bleeding, pain, vomiting, tiredness, and dizziness during surrogacy, after having gone through “great” pregnancies with her own three children. She was hospitalized several times, and in the twenty-second week began to experience 44 Part One: Dividing swelling in her left hand and then in her right. Soon her feet began to swell and cause her pain throughout the day, returning to normal only after she gave birth. When I asked Belle why she thought her illness had occurred, she asserted that the “hormones” had caused the bleeding and the pain: The pregnancy was different from a bodily perspective, but that is clear. . . . Here it was with hormones that change your moods and everything. It is because of the hormones that the pregnancy is different. It was also different because the hormones made me hungry, like the hunger that you get before you have your period. It’s the same. I also had a lot of bleeding. The bleeding continued up through the end. . . . And there were also all different unexplainable pains, like contractions of the uterus, things that have no explanation. . . . Look, the pregnancy is not natural, so there is always a 50 percent chance that it will take or that the body will push it out. Belle understands her bodily reaction to the pregnancy as a direct result of medical technology. However, such tales of bodily disruption occurred equally among surrogates who received hormone injections and those who conceived on “natural” cycles with no hormone preparation at all. Other factors, such as the amount of elapsed time since their most recent pregnancy, did not seem sufficient to the women to explain their body’s unfamiliar response to surrogate pregnancy. Instead, they seemed to strategically search for signs of otherness to maintain their classification of the pregnancy as unnatural. The surrogates’ descriptions of their symptoms as indicators of an “abnormal” pregnancy may be a narrative strategy they used to stress their distance from the role and identity of mother. This idea is further strengthened when these women’s pregnancy experiences are compared to those of their nonsurrogate cohort. A study conducted in the United States showed that nearly 90 percent of pregnant women surveyed experienced nausea or vomiting during pregnancy, and for 25 percent of these women, the symptoms continued through the twentieth week.24 These symptoms were so common that the conventionally pregnant women Murcott interviewed interpreted them as signs that their pregnancies were “normal.”25 Miller argues that physiological events have no meaning until actors choose to ascribe meaning to them, and that the same set of physical symptoms can be ascribed opposite meanings depending on the social role and identity with which they are associated.26 Miller found that those U.S. women who had planned their pregnancies and were ready to adapt to a “pregnancy identity” and social role interpreted symptoms such as Surrogate Selves and Embodied Others 45 nausea as a sign that they were pregnant. By contrast, those who had not planned their pregnancies and were not expecting these symptoms interpreted them as illness. In this light, surrogates’ interpretation of these symptoms as signaling illness rather than a “normal” pregnancy may be an expression of their desire to distance themselves from the role and identity of mother-to-be indicated by these bodily signs. This may be why the surrogates do not normalize their illness or downplay its significance but embrace its narrative power to stress the otherness of the pregnancy. These illness narratives can also be interpreted as subversive somatic commentary on the unpleasant effects of conceptive technology, which the surrogate blames for making her vomit, gain or lose weight, and lose her hair. Coker interprets the illness narratives of Sudanese refugees in Egypt as somatic testimonials to their political powerlessness and the loss of their land and community.27 Since the same pattern of symptoms and interpretations occurred among surrogates who conceived on “natural” cycles without hormones and among those who were medically prepared for conception, I would suggest that the surrogates, like the refugees, are expressing a type of somatic and narrative resistance to their situation. The cause of her bodily disruption is always other to the surrogate; it lies with the “artificial technology” or with the foreign couple/embryo that has taken up temporary residence in her body. The illness is never caused by her nature, and it nearly always contrasts with her earlier relatively easy personal childbearing experiences. The illness narratives may thus be considered symbolic expressions of the surrogate’s lack of freedom and structural powerlessness under the restrictive contract and surveillance of the body politic, medical institution, and contracting couple. In general terms, these illness narratives reminded me of spirit possession, which not only occurs predominantly among women but is also frequently interpreted as a reaction to structural powerlessness or being colonized.28 In an article published over thirty years ago, Graham explicitly compared the characteristic features of regular pregnancy with spirit possession;29 this comparison seems even more apropos when the body’s uncommon reaction during pregnancy is ascribed to synthetic substances and an embryo fertilized outside the body using another woman’s eggs. As I show in the following section, surrogates not only express symptoms of illness during surrogacy in common with the possession idiom, but they also experience cravings for particular foods, which is another characteristic of possession. In these ways, the surrogate somatically alludes to being possessed not just by technological artifice but also by her couple’s nature. 46 Part One: Dividing the other nature speaks up To this point, I have outlined the nature/artifice dichotomy as it is inscribed on the surrogate body. Yet as their metaphors demonstrate, women’s complex embodiment during surrogacy also includes the couple’s nature, which they incubate in the artificial body. Surrogates, thus, not only recognized how the artificial body differed from their own natural body but also identified the foreign presence in their bodies as the couple’s nature. This foreign presence in the body was most often seen as deriving from the intended mother alone, rather than from both members of the contracting couple. The presence of this other nature in the body was communicated most vividly in a surrogate’s food cravings, which she ascribed to her intended mother’s personality. Tamar, for instance, felt that her insatiable hunger during surrogacy could be attributed to her intended mother’s appetite: I had an appetite and I suppose, I think, that maybe that is because Miri, bless her heart, loves to eat. And her genes are also fat genes. . . . Because in my pregnancy with my daughter I didn’t have an appetite, and in my pregnancy with [Miri’s daughter] I ate a lot. I wanted to eat all the time. Tamar attributes her change in appetite to her intended mother’s genetic tendency toward fatness, as though by carrying her couple’s embryo, the characteristic tendencies of their nature could cause her to engage in unfamiliar binges. In addition to consuming large amounts of food, many surrogates claimed that they developed an affinity for foods they had not known or liked in the past. Most of these cravings were for foods consistent with a couple’s ethnic heritage. Sapir, for instance, whose background was Georgian, found that she intuitively craved the foods of her couple’s Ashkenazi ethnic cuisine: On Wednesday they did the return [embryo transfer], and on Thursday I knew that I was pregnant. . . . Because in my whole life, I never ate soup. I am not the soup type. Suddenly, I feel like having soup. How could you not see that I have an Ashkenazi inside? Suddenly, I want soup. And I would finish a whole pot every two days. And rugelach [an Ashkenazi sweet]. Sapir identified her cravings as specifically linked to a heritage that is foreign to her yet connected to her couple. This aided her in distancing the pregnancy from herself and in reassuring herself that there was no possibility that the child she carried was her own child. In Israel, Jews of European descent (Ashkenazi) have been privileged over other immigrant groups, including Jews who immigrated to Israel from Arab Surrogate Selves and Embodied Others 47 countries (Mizrahi). In this light, one might interpret Sapir’s cravings as a critical commentary on the colonization of her Georgian body by an Ashkenazi couple. However, ethnic differences were also commonly operationalized in the cravings described by Ashkenazi surrogates gestating the embryos of Mizrahi couples and by surrogates who associated themselves with various affiliations within the broad Mizrahi category. Thus, I interpret the communication of ethnic cravings in this context as a powerful signifier of differentiation.30 The communication of ethnically inspired pregnancy cravings also served to encourage intended mothers to foster a sense of identification with the pregnancy. Yael, an intended mother, told me how her surrogate’s cravings had affected her: Yael: One day, she called and said, “Yael, you know, I have a craving for this kind of soup that Moroccans cook.” I said, “I’ll tell you the truth. I don’t know how to make it, but I will ask my mom.” Elly: Is she [the surrogate] Moroccan? Yael: No, she is Iraqi. Elly: You are Moroccan. Yael: Yes. So I came and said to my mom, “Listen mom, it’s like this.” “What’s the problem?” [mimicking her mom’s voice]. At that same moment she prepared it, one-two. I took it to her [the surrogate], and she drank it. . . . What my mom says is, “If it was you, wouldn’t I do it for you? If you had the craving? So this is the same thing.” Her surrogate’s craving for a soup particular to Yael’s Moroccan heritage and foreign to her own Iraqi ethnicity gave Yael the opportunity to involve her mother in the pregnancy and to feel more connected to it herself, as if it were occurring in her own body. In a later conversation with Yael, I learned that this soup was particular to the part of Morocco from which her parents had immigrated, very specifically identifying the pregnancy with Yael and distancing it even more clearly from her surrogate. Other surrogates also emphasized the distinctive nature of their food cravings and interpreted them as strange and particular to surrogacy. Tilly, who was Iraqi, referred to her couple’s ethnic background when she claimed to have “a real taste for Ashkenazi food during this pregnancy.” Likewise, an Ashkenazi surrogate named Sherry told me that that she had a particular taste for the spicy condiment harif during the earlier months of the pregnancy, which she thought might reflect the food tastes of her Mizrahi couple. The surrogates seemed to experience 48 Part One: Dividing cravings that accorded with their intended couples’ ethnic heritages to different degrees of specificity, depending on the extent of knowledge of couples’ backgrounds. For instance, Ariella, whose surrogate was a recent immigrant from Russia, reported that the surrogate craved a food that was not particular to her own ethnic group but that seemed to generally symbolize her ethnicity to her surrogate: Ariella: I asked her if she wanted me to make her something, if she had a desire for something. So she said, “I bet that Yosi’s [Ariella’s husband’s] mother cooks well.” So I said to her, “So do I.” So she said, “I have a taste for couscous.” Elly: That is not a food she regularly eats, is it? Ariella: Are you kidding? She’s Russian. They don’t even cook, the Russians. They only buy prepared food. And never couscous—what’s the connection at all between her and couscous? Elly: But you are Persian. Do you eat couscous? What is Yosi? Ariella: Yosi is Egyptian. But I do make couscous. And anyway, I think that she didn’t know exactly what we were. She thought that we are Mizrahim and that Mizrahim eat couscous. The cravings described by surrogates are particularly interesting in light of studies of conventionally pregnant women showing that they typically crave foods they normally eat.31 The women Murcott interviewed interpreted whatever food aversions or cravings they had as “normal” symptoms of pregnancy and as part of their general attempt to frame pregnancy as an ordinary experience. They refused to indulge in or to live out any of the bizarre stereotypes of pregnancy behavior popularly characterized as odd or peculiar.32 This normalizing behavior stands out against the surrogates’ emphasis on the distinctive nature of their surrogacy appetites. When surrogates crave the salty soups of their couple’s ethnicity, for instance, they stress the naturalness of the pregnancy for the intended mother and its distance from the surrogate’s own ethnicity. Moreover, they illuminate the relationship between self and other within their bodies. As Lupton observes, when eaten and absorbed, food becomes part of us.33 Food crosses our bodily boundaries, becomes part of us for a temporary period, and then is expelled from the body. After we ingest it, food enters a liminal phase in the body, which Lupton compares to the liminal presence of a fetus in a pregnant woman’s body. The surrogate’s craving for her couple’s ethnic foods expresses the ambiguous situation she embodies: she encourages the couple (their food and their nature) to cross the boundaries of her body for a temporary period. It is clear to her all the while that her hunger is not her Surrogate Selves and Embodied Others 49 own but the hunger of the foreign nature she carries. The presence of the couple/fetus in the body thus affects her behavior, but she recognizes it as “other” than herself. The ability to identify the couple’s foreign nature within the artificial body was most vividly portrayed by Ye’ara, who was a surrogate twice, for different couples. The intensity of Ye’ara’s portrayal may be linked to the extreme differences in ideology and lifeworld that existed between her and her couples. Both couples were ultra-Orthodox Jews, while Ye’ara was not just secular but antireligious. Indeed, she had not married her common-law husband, Natan, who had been her partner for fourteen years, out of protest against the religious authorities that govern marriage in Israel; she vowed only to marry when civil marriages were permitted. Yet she had deliberately chosen to contract with ultra-Orthodox couples because she was interested in bridging differences between the secular and the religious and felt that the surrogacy experience in each case would be an interesting challenge. Natan, whom I also interviewed, observed how Ye’ara displayed behaviors foreign to herself in each of the pregnancies. In both pregnancies Ye’ara was nauseated, which she had not experienced while gestating her own two children. Moreover, Natan reported that during the first surrogacy Ye’ara craved certain condiments she usually abstained from, became ill at the thought of meat, and was repulsed by food in general: She changed all of her tastes. . . . She liked to eat only this and that. It was as if a dibbuk [spirit] had possessed Ye’ara and was carrying out the process through her. . . . Things that [she] never ate, like ketchup and mayonnaise . . . there were all different things that you could see that it wasn’t the same person that was there before. The second pregnancy, by contrast, gave her an unusually ravenous appetite, a particular taste for cola, and a craving for barbecued meat. As a participant observer in Ye’ara’s surrogacy experiences, Natan identified the foreign presence in his wife’s body during surrogacy by reference to a dibbuk—a Jewish idiom referring to possession by an often-troublesome spirit. His spontaneous comparison between the surrogate pregnancies and spirit possession recalls Graham’s observation that, in both pregnancy and possession, the individual’s body is “invaded” by an alien being whose presence explains her behavior and exempts her from responsibility for her actions.34 Yet the presence in Ye’ara’s body was not an abstract entity but directly linked during each pregnancy to the intended mother’s personal 50 Part One: Dividing characteristics. Thus, Natan observed changes in Ye’ara’s behavior as manifestations of the intended mother’s personality. Describing the intended mother in Ye’ara’s second surrogacy as a lethargic, sickly, terrified, and hysterical woman, Natan observed that Ye’ara’s usual good health, optimism, courage, and rational thinking temporarily vanished, leaving her uncharacteristically unsure of herself, needy, physically weak, and plagued by irrational fears. He even ascribed Ye’ara’s temporary aversion to her usual compulsive tidying up of the house to her intended mother’s characteristic untidiness. Ye’ara, on her part, saw these changes in her personality and tastes as the logical outcome of surrogacy, explaining that it “sounds so logical to me. It really makes sense. Because it is another person’s baby, a different [person’s] personality and different hormones.” Throughout the second pregnancy, she knew, she said, that what she was experiencing was the intended mother’s nature making itself known: “All of the heavy feelings and the difficulty and feeling unwell, I’m not like that. . . . But I had days here that I couldn’t even move a glass from one place to another. It wasn’t me. That’s why I was so eager to give birth already, because I wanted to get my life back.” Indeed, during the birth, Ye’ara experienced a marked transition back to her former self: “The fact is that during the birth, I returned to be who I am.” The idea evoked in the women’s tales of the foreign nature in their bodies is similar in many ways to a phenomenon found among organ transplant recipients. Fox and Swazey note that both givers and receivers of organs engage in an animistic, magic-infused thinking.35 Donor families often feel the need to meet the persons who received the cadaver organs of their loved one and to have contact with the part of their deceased relative that “lives on” inside the recipient’s body, and recipients sometimes describe changes to their personalities after receiving a donor organ that they liken to the donor’s characteristics. Sharp found that this occurred even when the recipients did not know who their donors were (organ donation is usually anonymous).36 Recipients still imagined that they had acquired some of a donor’s characteristics, especially when the transplanted organ carried strong metaphoric and symbolic meanings, as in the case of the heart. Sharp interprets this behavior as the recipient’s attempt to restructure his or her self after the transplant, a feat that can be achieved either by the incorporation of the organ into the recipient’s “transformed” self or by neutralizing the organ’s origins and mechanistically considering it a “spare part” that has no effect on the recipient’s self.37 Surrogate Selves and Embodied Others 51 Surrogates combine both strategies of restructuring the self while temporarily “carrying” the foreign organ/embryo. They selectively distance some bodily phenomena by ascribing them to “artificial” technology and other bodily occurrences by referring to them as manifestations of the couple’s nature. Together, both strategies not only aid them in signifying what parts and behaviors are “other” to themselves but also help them recognize the boundaries of their personal selves within their “occupied” bodies. the nature of nature Why do surrogates hold so steadfastly to this scheme during surrogacy? What other meanings does the nature idiom carry, and what is at stake if it is not carefully preserved? One explanation may be that, by emphasizing the naturalness of their maternal attachment to their own children, surrogates are able to confirm their normativity as women and as mothers. Their articulations are consistent with those discussed in other studies of assisted conception that often employ nature as an idiom for reconciling technological paths to parenthood with normativity.38 Indeed, Thompson has shown the power of this idiom across different technologically assisted contexts in which consumers “strategically naturalize” genetic, gestational, or social elements, depending on the procedure they use.39 Yet surrogates’ distinctions between nature and artifice are not entirely consistent with studies of women’s attitudes toward fertility treatment more generally. Studies in the United States and Britain have shown that IVF patients tend to discuss the technology itself as “natural,” as a “bridge” to nature, as giving nature a “helping hand,” or as keeping it on course before the body picks up and itself continues a pregnancy “naturally.”40 The emphasis that the surrogates in my study put on the unnaturalness of the technology speaks to the importance they ascribe to keeping their personal “nature” untouched by the surrogacy process. It is the unnaturalness of the process that enables the surrogate to explain her distanced emotional response to the baby and to confirm to herself and to others that she is not deviant, even as she engages in the nonnormative act of agreeing to relinquish a child that she births. Surrogates’ attempts to denaturalize technology are also revealing about their stance vis-à-vis the technology itself. Whereas persons influenced by dogmatic Christian beliefs may view human intervention in 52 Part One: Dividing “nature” as an affront to G-d’s will, many Jewish scholars agree that such technology is not necessarily morally contentious.41 Indeed, Israeli policy makers have expressed fewer serious ethical and moral reservations regarding reproductive technologies than have been raised in other Western countries.42 In Judaism, the divine commandment to “be fruitful and multiply” is regarded as binding, especially in the realm of human reproduction; it is telling that this commandment is combined with a second divine command to “subdue the earth.” In the realm of reproduction, humans are thus not only entitled but also mandated to “interfere” with G-d’s creation—it is morally permissible and mandated to alter “nature.”43 Thus, surrogates’ emphasis on the unnaturalness of technology may be influenced by a decidedly Jewish approach to technological intervention in “nature.” Surrogates’ approach to “nature” also has repercussions for gender. As feminist anthropologists have long argued, following Ortner’s influential essay on the essentialist conflation of biological functions and social characteristics,44 in many societies women have historically been hierarchically affiliated with nature, whereas men have been associated with culture. Strength, firmness, and aggression are represented as the natural characteristics of the male body, and liquidity, animality, and leakiness are represented as the natural condition of women.45 Surrogates seem to be upholding these “naturalistic views” of the body that legitimize gender inequalities.46 Their idea of nature is that of an uncontrollable, emotional, instinctual, and dangerous substance that must be controlled, subdued, and contained by medical technology, an arena considered in the radical feminist literature to be dominated by men. The surrogate’s idea of nature is also used to maintain a sense of normativity that equates womanhood with motherhood—an equation that feminists have made great efforts to break apart.47 This idea thus seems to express subjugation and surrogates’ willingness to submit to male control of their bodies to override the supposed hysterical qualities of their allegedly inferior female “nature.” At the same time, surrogates’ narratives reveal an important subversive commentary that simultaneously upends and reifies the patriarchal idea of biology as women’s destiny. Surrogates may be submitting their bodies to a doctor’s control, but only to use that external harness to control the outcome of their own actions. In particular, they may believe in an essentialist idea of nature, but they also exemplify the empowering idea that a woman can become independent of the influence of her so-called nature. Engaging in actions similar to those Thompson has Surrogate Selves and Embodied Others 53 described as “agency through objectification,”48 they invoke the same technological representations (IVF, mechanistic metaphors), which critics see as alienating women, in order to exercise personal agency. These women believe that by embracing the power of technology to control their bodies and through their own complex cognitive classifications (nature, artifice, other nature) and self-objectification (mechanistic womb metaphors), they have the power to overcome any innate emotions and “natural” uncontrollability that may stem from their bodies. They may therefore believe that women are destined to become mothers, and they may submit themselves to patriarchal control, but they also subversively use the tools of patriarchy—medicalization, objectification, and technology49—to make sure that “maternal nature” manifests itself only where and when they want it to.