Françoise Baylis and Ryan Tonkens discuss the expanding scope of the commercialization of human reproduction.

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Payment for contract pregnancy is illegal in some countries, for example Canada, but in other countries, including the United States, paying women for gestational services is both legal and a viable business.

Common ethical concerns with this practice include the exploitation of women and the commodification of children. We share these concerns, especially in light of the expanding scope of the contractual arrangement between intending parents and the women who sell their reproductive labor. As the demands of prospective parents that seek out contract pregnancies expand, and as these expanded demands are met with the increased prospect of financial gain, there is a real risk of further undue commercialization of women and the process of human reproduction, treating both as products to be bought and sold.

As recently reported in the New York Times, gestational women can now sell their breast milk for months, or even years after giving birth and handing over the child to the intending parent(s). If the price is right, then the breasts of gestational women are now for rent along with their wombs.

In the U.S., the sale and donation of human breast milk has been going on for years. Milk banks procure, screen, and distribute human breast milk to hospitals at a cost of about $4 an ounce.  Breast milk can also be purchased on the Internet, where the price ranges from 50 cents to $3 an ounce. As breast milk is considered a food substance, it is not subject to the regulations that govern other bodily fluids and tissues (e.g. organs and semen).

With contract pregnancy, typically the rich are paying the impoverished to gestate their babies, and now, breast milk is being included in pregnancy contracts. In the case of C, discussed in the New York Times article, a rich white couple in their late 50s with three biological sons wanted to experience raising a daughter. They paid C, a poor 39-year-old woman with five children from two previous relationships, $35,000 to make them a baby and to provide breast milk.

The purchase of breast milk can be seen as evidence of loving, caring parents who want to provide the best for their newborn. Breast milk is better than infant formula because it is a richer source of nutrients (e.g. fatty acids essential for brain development) and natural antibodies against certain diseases, and it has been shown to decrease the incidence of allergies in breast fed children. The benefits of the act of breast-feeding are separate from (and in addition to) the benefits of breast milk. The skin-to-skin contact promotes a loving bond and sense of security. The newborn also gets early exposure to the natural flora of the breast-feeding woman, allowing her to build up resistance to the natural bacteria that she will be exposed to in her home environment. These benefits are forfeited in cases where gestation and breast milk are contracted out.

The practice of including breast milk in pregnancy contracts is perhaps a harbinger of things to come. In the extreme, we can imagine the role of women working under contract for intending parents expanding significantly. Their list of contractual duties could include: providing gametes; accepting embryo transfer; carrying the developing fetus(es) to term; doing all that is necessary during the pregnancy to ensure fetal health; birthing the neonate(s) following a birth plan dictated by the intending parents; providing breast milk to nourish the newborn infant(s); providing child care services; and when the child(ren) is/are sleeping or being entertained by the legal parents, perhaps do a little housekeeping and cooking; and so on.

Indeed, a recent news story about a woman in New York who offered her nanny $30,000 for her eggs, with the assumption that the nanny would then raise the new child along with the existing children, suggests that this scenario is not as far-fetched as it might first appear.

To be sure, in the near term, intending parents may be reluctant to extend the contractual arrangements with the gestating woman this far, because of uncertainty regarding legal guardianship. It is not difficult, however, to imagine two or more women together providing this full range of reproductive and childrearing services under contract. This future prospect behooves us to ask and answer the following question: Is there anything morally wrong with reducing parenting to a legal relationship, while others bear, birth, nourish, and care for the children one claims to parent? Our short answer to this question is yes. And, regarding the issue at hand, we worry that the expanding scope of commercial contract pregnancy to include breast milk is a wrong step in the direction of reducing parenting to a legal relationship, more so than a caring one.

Those who do not share this view may point out that, for centuries wet nurses were paid by women of higher socioeconomic status to provide sustenance for their newborns, either because the women could not breast-feed or because it was socially unacceptable for them to do so. But neither of these factors explains or justifies why women today who buy gestational services also buy breast milk and more. Women who have not been pregnant can produce breast milk sufficient to nurse a newborn if they are so inclined. This can be accomplished by taking domperidone a few months before the anticipated birth of the child. Domperidone, a prescription medication for stomach and intestinal problems, is routinely used off-label to help with breast milk production in women experiencing insufficient lactation. Last year, the Motherisk program at The Hospital for Sick Kids in Toronto reported, on the basis of a meta-analysis of relevant trials, that domperidone increases breast milk supply. There were no maternal safety issues with the use of this drug as compared with placebo, and there were no side-effects in the breast-fed infants. Thus, women who contract with other women to make them a baby (and adoptive parents as well) could breastfeed ‘their’ newborn and do so without social approbation. We believe they should at least try to do so.

Where procreation and parenting risk becoming things you just purchase from others, there is a real sense in which important elements of those practices are being compromised, including the bond between mother and child.

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Françoise Baylis, Professor of Philosophy and Bioethics, Dalhousie University
Ryan Tonkens, Postdoctoral Research Fellow, Novel Tech Ethics, Dalhousie University

[A different version of this commentary has appeared on The Mark News, here]