What’s Bubbling Up: Emergent Markets in Reproductive Tourism

Introduction

The reproductive tourism markets in India, Eastern Europe and the United States are by now well-established and well-documented. These popular destinations are supported by sophisticated global marketing strategies, an array of satellite industries, permissive regulatory environments, and even diplomatic interventions to facilitate cross-border surrogacy arrangements. However, these same markets are under increasing pressure to tighten regulations and pay more attention to ethical concerns. A 2010 survey by the European Society of Human Reproduction and Embryology (ESHRE) and the International Federation of Fertility Societies (IFFS) documented 105 countries in which fertility services are now offered, up from 59 just three years earlier.^[i] Although growing domestic markets are undoubtedly behind much of this increase, there are also signs that reproductive tourism is contributing to the rapid growth.

So, how is reproductive tourism unfolding outside of the destinations we’re familiar with? What developments are just beginning to bubble up to the surface in academic and advocacy circles in the United States? I took a look at a few recent cases with the goal of rounding out our picture of what, exactly, reproductive tourism looks like today, and where it may be headed in the future, and I drew three preliminary conclusions.

Barbados

In the current economic climate, countries looking to generate revenue are turning to reproductive tourism, and campaigns to capitalize on the industry continue to surface in new settings.

The Barbados Hotel & Tourism Association defines its primary role as lobbying the government to advance the business interests of its members. It sits on the Board of the Barbados Tourism Authority as well as 60 other government committees. Barbados is not well known as a destination for reproductive tourism, but it’s hoping to get into the game. According to the International Medical Travel Journal, in 2009 the association began promoting Barbados as a destination for “infertile women” following a sharp decline in the number of traditional tourists. The association’s Executive Vice-President publicizes a single provider in her association’s promotions: the Barbados Fertility Centre.^[ii]

In 2010, the Barbados Fertility Centre surveyed nearly 2,000 American women ages 25 to 45 in order to learn what would motivate them to seek IVF overseas. They ranked the participants’ motivations (including potential for beach time)^[iii]as well as likely barriers.^[iv] Capitalizing on Barbados’s cachet as a luxury vacation destination and its substantial tourism infrastructure, the Centre then designed four “Holiday with a Purpose” accommodation packages. The packages include a private luxury car on arrival and a pre-programmed cell phone so that couples can be reached on the beach for their appointments. The marketing campaign emphasizes that luxury vacations decrease stress, which in turn increases chances for successful treatment. As the website puts it, “[W]hat better place in the world to reduce your stress than in the exotic island of Barbados in the Caribbean.”^[v] Those of you familiar with the development and marketing of reproductive tourism to India will recognize elements of this approach.

Nigeria

The popular perception that traffic for reproductive technologies and reproductive tourism flows one way, from the Global North to the Global South, is increasingly proving inaccurate. Niche industries have sprung up in Thailand and Jordan, for example, to cater to Indians seeking to get around India’s ban on PGD, or pre-implantation genetic diagnosis, for sex selection. These industries are also catering to Australians and other Western nationals looking to determine the sex of their child.[vi]

A second and perhaps less familiar example is Nigeria. We tend not to recognize that fertility clinics exist to serve a domestic market in sub-Saharan Africa. But fertility services have been available for some time. The Bridge Clinic, established in Lagos in 2001, claims that “[m]ore than a thousand babies have been born as a result of treatment.” The first successful surrogacy took place there in 2003. The clinic offers a wide array of services, including a sperm bank, donor insemination, egg donation, IVF, and “IVF surrogacy” at its four facilities around the country. “In the absence of a regulatory authority in Nigeria,” it also established an Ethics Committee that advises the clinic on “moral and ethical issues such as the use of donor gamete[s] and surrogacy cases.”[vii]

In June 2011, the clinic hosted a symposium to stimulate debate around ARTs, with the apparent goal of prompting the Nigerian government to implement regulatory guidelines. The Pentecostal, Catholic, Anglican and Muslim clerics in attendance roundly condemned IVF as immoral and unnatural, and surrogacy “nearly drove them mad,” in the words of one journalist. The clerics called it ungodly and unthinkable. Physicians, on the other hand, said “whatever would make a couple happy should be allowed.” Everyone agreed, however, that single women and same-sex couples should be explicitly prohibited from accessing services. The clinic appears poised to expand its surrogacy program, which until now has operated under the radar. One stated outcome of the conference is that SOGON, the Society of Gynaecology and Obstetrics of Nigeria, will develop a draft law on assisted reproductive technologies.[viii] The Bridge Clinic may see the government’s stamp of legitimacy in the form of regulation as an important selling point to potential clients both in and outside Nigeria.

Guatemala

As the intercountry adoption industry has shrunk in response to global regulation, adoption service professionals are transferring their expertise and using their existing in-country networks to enter the global surrogacy industry.

The Hague Convention on Intercountry Adoption, which has been ratified by more than 70 countries, is an international treaty that protects children’s rights in intercountry adoption. The number of intercountry adoptions worldwide has dropped considerably over the last ten years as ratifying countries have come into compliance with the Convention, numerous adoption scandals have unfolded, and the top sending nations, in particular South Korea, Russia and Guatemala, have done some soul searching. Karen Smith Rotabi, Professor of Social Work at Virginia Commonwealth University, has identified a substitution effect of this decline:  “As adoption has become more difficult, the global surrogacy industry has begun to surge to meet the fertility demands of individuals and couples seeking to secure healthy infants. A handful of adoption agencies and service providers with prior significant interests in Guatemala have been shifting to meet this need.”^[ix]

Soon after Guatemala ratified the Convention, it shut down intercountry adoption in light of accusations of coercive child relinquishments, the absence of independent counseling or an informed consent procedure for birth mothers, and the context of extreme poverty in Guatemala.^[x] Guatemala was for years a significant source of infants for adoptive families in the United States. In 2006, the New York Times reported that nearly one in every 100 babies born there was adopted by an American family.^[xi] Some US-based agencies with expertise in intercountry adoptions from Guatemala are now turning to commercial surrogacy to fill that gap. For example, Adoptions from the Heart, an agency founded in 1985, now offers gestational surrogacy in Guatemala.[xii] Their site lists just two downsides for international surrogacy, giving some insight into the breadth and depth of consideration they give to ethical concerns: “It is [a] controversial topic but is gaining recognition due to the large number of celebrities who are turning to gestational surrogacy to start their families” and “The surrogates may face medical / obstetric complications during pregnancy which puts extra financial burden on the commissioning couple.”[xiii]

Other agencies are overt about the transfer of their expertise in Guatemala from adoption to surrogacy. The Florida-based agency Advocates for Surrogacy promotes its program with the claim that, “Our President directed a successful adoption program in Guatemala for many years working with the attorney and team in Guatemala who now heads up our Guatemala surrogacy program….”^[xiv]

The agency draws an explicit link from their involvement in a system that was shut down because of rampant human rights violations and their current surrogacy program: “The day to day logistics of managing an adoption program and surrogacy program are quite similar - we have been able to easily transition from the careful oversight we exercised over our foster mothers to the careful oversight of surrogates that this program requires.”^[xv]

Closing

Some of these stories underscore trends we’ve seen elsewhere, for example, that governments continue to look to reproductive tourism as a lucrative growth industry that can bring in foreign currency and drive expansion of numerous core and satellite industries.[xvi] Wherever they are, it also appears consumers like to “jurisdiction shop,” or gravitate toward less restrictive regulatory settings,[xvii] and that these settings routinely change as established markets tighten up and new players step into the gap. At the same time, some players in the industry look to government to legitimize them.

Other stories point to new developments, such as the growing visibility of regional and domestic markets in Africa and Asia. Although Europeans and North Americans remain an important customer segment, consumers from the Global South are seeking services closer to home. It’s worth remembering that countries in the Global North have also long been supply countries, often for customers coming from the Global South when services were not available.

These cases give us a taste of what’s stirring beyond the public eye. Most of it is not being talked about in mainstream media in the US or Europe, but I believe it deserves our further attention. It is my hope that these brief case studies can point to some promising areas for future research and analysis.