Assisted reproductive technology has grown significantly in Australia as in other countries and hundreds of thousands of children have now been born because of it around the world. Most of us know people who’ve had children this way.

But there’s another side to assisted reproduction with which Australians are less familiar. You may know that it’s often difficult for infertile couples to find suitable egg donors if a woman cannot produce her own eggs or if her eggs are not able to be fertilised.

And it’s even harder for couples to find a surrogate mother if they can’t have a child themselves, or they want to have a child who is biologically related to both of them (especially as payments and other rewards have been prohibited in Australia).

You may have heard of “reproductive tourism”, where people travel to another country to undertake procedures that Australian women may be unwilling to undertake, or that would be unlawful in Australia. But most of us know little about the experiences of people in those countries who are drawn into these activities.

Kishwar Desai’s Origins of Love tells the story of a range of people involved in assisted reproductive technology and surrogacy: the desperation of English couple Jane and Ben to have a child and their heartbreak after a series of miscarriages; the participation of young Indian women like Preeti and Sonia who donate their eggs and undertake surrogate pregnancies as a way out of gruelling financial and family problems, often encouraged by or coerced by husbands who have no hope themselves of earning the sums offered to their wives for surrogacy; the role of doctors in ART clinics and hospitals in England and India (some with ulterior motives); and corrupt government officials handling imported human embryos in the Indian customs department.

The book is a page-turner as the reader becomes absorbed in the lives of the characters and the role of social worker Simran Singh in investigating the multimillion dollar surrogacy industry. Getting to know the characters gives an insight into the issues around assisted reproductive technology and surrogacy in a human context.

The themes of the book are best illustrated by examples. First, the heartbreak of childlessness and the desire to have one’s own child are highlighted:

Commenting on “the large number of unwanted children in [India]”, Simran asked why they should not simply encourage childless couples to adopt. The doctors reply that some of these women “are willing to do anything at all to have that child. Anything. Some of the husbands are totally obsessed too – [and also] … lesbians.” pp 108-9.

And it’s not only foreign women who want an Indian surrogate mother. A powerful government official in India whose first child was so disabled as to be socially embarrassing could have a second baby “made-to-order …. It would be as though she had borne it herself, but without the bother of a pregnancy. And there would be no gossip, either, because she could say she had adopted the child.” (p. 195)

For these women, a surrogate can be chosen taking account of caste, an important consideration in Indian society.

The role of men as sperm donors is also considered. One cannot read the scene in the sperm donation centre without thinking about the recent requirement under Victorian law that sperm can no longer be donated anonymously:

“There was a row of cubicles like changing rooms in garment stores: some had doors and others just had curtains. From behind the curtains came grunts and moans and even gasps. One curtain shifted and a young man, barely out of school, with adolescent pimples still on his face, staggered out, zipping his trousers and holding a cup in his hand.” (p. 274)

The stories of the Indian surrogate mothers during their hospital stay are especially poignant. Uneducated, poorly-nourished country girls are given good food and vitamins, made to exercise, have their skin whitened and their hair styled before being photographed for selection by commissioning parents in other countries.

Despite a background of deprivation, one girl spending the gestation period in the “squeaky-clean hospital” worries about her husband’s fidelity with another woman staying in their house and is homesick for “the sunrise over the rice fields, the sharp clucking of the hens, … the dirt roads and the smell of the cow pats.” (p. 287)

An increasing number of human embryos are imported into India from other countries and, in the book, bent officials turn a blind eye: “[A] lot of things go on in India under the radar.” (p. 308) Desai explores the human story of how new recruits who are otherwise inclined to honesty and fair play are drawn into corrupt practices.

In some sections, the discussion of ethical issues is more direct. I read the parts about embryonic stem research with particular interest, having served on the two principal legal and ethical reviews on this issue in Australia (the Lockhart and Heerey Committees). The points are accurately but simply made, for example:

“[E]mbryonic cells were the miracle cure. They had the power to take the shape of whatever damaged part of the body they had been injected into and provide a replacement… [But] the wrong part of the body might suddenly grow instead of the part that was being cured.” (p. 426)

This is an engaging and stimulating book that examines important current issues about fertility and assisted reproduction. It focuses principally on the human relationships through which these issues are played out. Thinking about how people become involved in the “surrogacy industry” and the impact it has on their lives may affect the way we view the ethics of reproductive tourism.

Origins of Love by Kishwar Desai is published by Simon and Schuster

This is the final part of our short series on motherhood. Click on the links below for other articles in the series:

Part one: A womb of her own: risking uterus transplant for pregnancy

Part two: He’s my mother: motherhood across gender boundaries

Part three: IVF treatment for older women: is age the greatest concern?

Part four: Hilarious or horrifying? Foetuses Photoshopped onto bellies