By Elly Teman
Berkeley: University of California Press, 2010. 361 pages. $21.95.
With an estimated one in ten couples suffering from infertility, the presence of assisted reproductive technologies has become a global phenomenon. Yet its increased prevalence has also led to images about those involved in these procedures: egg donors are overpaid, beautiful young women out to make a killing at the expense of superficial parents who seek biogenetic perfection, while infertile women are driven to make irrational and costly decisions in the service of pregnancy, not parenthood. Then comes the surrogate, likely the most contentious figure in the assisted production world. Surrogates are generally figured as poor women who rent out their wombs as a last resort only to have their bodies exploited by medical professionals and intended parents. They are either imagined to be devastated when the infant—with whom they bonded in utero—is taken from them, or they are labeled deviant for not bonding with the fetus in the first place.
This serves as the myth that Elly Teman seeks to overturn in her ethnographic study Birthing a Mother: The Surrogate Body and the Pregnant Self. Using tools from feminist theory and anthropology, Teman documents the journey of gestational surrogates (i.e., surrogates who do not provide the ova) and intended parents in Israel as together they create new families. The book is organized into four sections. In the first, Teman discusses how the surrogate navigates the process’s terrain, including how she organizes her body map and understands her identity in relationship to the fetus. Teman documents how surrogates distance themselves from the fetus while forming an intimate bond with the intended mother by allowing her to feel the belly, share personal aspects of the pregnancy experience, and participate in ultrasounds and other medical events.
In the second part, Teman focuses on the journey of the intended mother and how she constructs a “pregnant identity” during the surrogacy process in a way that prepares her for motherhood (134). Here Teman addresses practices such as choosing a surrogate, taking hormones to induce lactation, and couvade. These contribute to the phenomenon Teman terms the “shifting body,” a process that transfers from the surrogate to the intended mother a pregnant and (later) maternal identity (134).
The third section considers how intended mothers and surrogates interact following the birth as well as how the state and medical establishment figure in this process. Teman also discusses the difference between the surrogate gifting a baby and someone completing a contractual exchange in which the baby is the object exchanged. She argues that surrogates often enter the process considering their actions to be primarily of the latter nature, but as their journey through surrogacy proceeds, they increasingly see themselves as gifting a baby, motherhood, and the creation of a nuclear family.
The final section of the book explores how, contrary to the popular stereotype, the surrogate images herself not as an exploited woman but as a hero on a mission that defines her purpose in life and gives her a defined place in history.
Teman explores several prominent themes throughout the study. First among these is the implication surrogacy has upon the construction of both body and identity for the surrogates and intended mothers. Throughout the book, Teman impresses that counter to popular belief, the majority of Israeli surrogates are empowered by the process of birthing a child for another couple. Several, in fact, experience a kind of apotheosis as a result of the experience. In the words of one surrogate, “I feel good about myself and proud of myself. … I am already signed up in heaven. … I did my mitzvah. … I did my good deed [ma’aseh tov] in life. I can be regular now” (270). Or, as one father said about his surrogate, “You are G-d for us” (271).
The second theme permeating the work is the dynamic that develops between the surrogate and intended mother. Teman writes about how an intense bond often grew between the two women, beginning with a kind of chemistry or “instant attraction” that resembled a romance (135). The women gradually integrated into one body, feeling that they shared everything from moods to sympathy pains to a soul. Yet they did so in a complementary way; for instance, the surrogate avoided touching her belly but encouraged the intended mother to do so, and she likewise avoided bonding with the baby but helped facilitate moments that offered that opportunity to the intended mother.
Finally, Teman touches upon how surrogacy practices are influenced by the political priorities of Israel, as well as how that affects the regard in which surrogates are held. She repeatedly explains that birth is considered a national priority for Israel, both because of the biblical injunction to be fruitful and multiply and because birth literally enables the continuation of the nation. As a result, Israeli cultural expectation is that women will birth children, and this is facilitated by a state health plan that covers seemingly unlimited IVF attempts—Teman writes of women sometimes undergoing IVF over 20 times—as well as surrogacy and egg donation. The Israeli government also gives a monetary sum to women upon the birth of each child, and the cultural milieu is such that to be a single parent is far more acceptable than to be childless but married. As one surrogate reflected, “Until you have a child, there is no continuing generation and no reason to live. … This couple has no continuing generation, and if they don’t have a child, then they will simply be erased from this earth” (267).
Ultimately, this reviewer sees Birthing a Mother as having provocative implications regarding the formation of relationships in the surrogacy process. In countries such as the United States, an aura of secrecy surrounds assisted reproductive technologies: a majority of egg donors and sperm donors are anonymous and many surrogates never meet their intended parents because of either privacy concerns or geography. This separation has become the norm, such that those assisting in assisted reproductive technologies—donors and surrogates—and those who become the recipients of that assistance—intended parents—can go through the entire process of creating life never having to encounter one another. This system exists, at least in part, because of concerns that having ongoing relationships with one’s donor or surrogate could lead to a kind of ontological confrontation wherein mothers or fathers question their legitimacy.
Yet what Teman’s study encourages us to consider is whether this need be the case. Teman documents that when greater distance existed between the surrogate and intended mother—except in situations of inappropriate enmeshment—the process became less fulfilling for both parties. Teman also cites difficulties arising when the medical establishment—whom she figures as having patriarchal overtones—encouraged intended parents to cease contact with their surrogates following the birth instead of letting a more organic transition occur that was more aligned with embodied feminist ideals.
In this regard, the American reader is left asking whether intended parents, surrogates, and others who assist in reproductive technologies in this country—such as egg and sperm donors—are functioning in a climate of fear that leads to secrecy and therefore missing the possibility for deep and enduring bonds. Or, put differently, by contrasting the norm in Israel with that in the United States, the fear that permeates the American assisted reproductive network is given stark relief. Teman’s work, therefore, causes the reader to implicitly critique the secrecy that characterizes the American system and to ask whether there might be a way for both the births and the relationships resulting from assisted reproductive technologies to be fruitful.
Elly Teman’s book is an exhaustive, thoughtful ethnography, possessing fluid yet technical writing that reads like a page-turning novel. It will no doubt become a seminal work in the fields of feminism, anthropology, and assisted reproduction.