Elly Teman, Birthing a Mother: The Surrogate Body and the Pregnant Self. Berkeley: University of California Press, 2010. Paperback, 384 pp., $29.95. ISBN: 9780520259645. 

Surrogacy, Elly Teman (2010) claims, is not just a new way of having children, but it ‘upsets the moral framework in which reproduction is regarded as a “natural fact” grounded in love, marriage, and sexual intercourse’ (p. 7). Teman’s ethnography focuses on gestational surrogacy in Israel, which is the practice of women carrying children for infertile ‘intended parents’; the foetuses are usually genetically related to the intended parents or (partly) to a donor. The book is based on fieldwork Teman did over a period of eight years with twenty-six surrogates, thirty-five intended mothers, and some partners and professionals involved in surrogacy arrangements. Teman’s research gives insight into the lived experiences of surrogacy, making it an important work to consider in current debates in which the voices of the people involved in surrogacy are not always heard.

Israel is an interesting place to study surrogacy: it is one of a few places in the world where commercial surrogacy is legal. Further, motherhood and having a family are very important both in Judaism and in Israeli national discourse, and because of the small size of the country, there is little geographical distance between surrogates and intended parents. Teman argues that because fertility treatments (though not surrogacy costs) are covered by health insurance ‘instead of being reserved for the economically privileged, commercial surrogacy is more readily available to Israel’s middle class’ (p. 25) compared to other places. However, this does not mean that surrogacy is available to all: only Israeli citizens are allowed to participate, surrogates and intended mothers must be of the same religion, and the process is available only to heterosexual couples. In addition, interested parties undergo extensive screening processes that involve the government, and long trajectories of fertility treatment are required.

Teman’s ethnography is divided into four parts. In the first, titled ‘Dividing’, Teman discusses how surrogates in her study distanced themselves from the pregnancy through framing themselves as just a ‘host’, creating a ‘body map’ where they emphasized their heart as personalized and their womb as depersonalized, and highlighting how different their surrogate pregnancy was from earlier pregnancies. Intended mothers on the other hand, actively tried to connect with the process and the growing baby through ‘claiming practices’, such as emphasizing the importance of genetics, which is discussed in the subsequent part titled ‘Connecting’. Intended mothers tried to be involved in the pregnancy, so that doctors would see them as the primary patient or part of the ‘conjoined patient’. Throughout the process, intended mothers and surrogates saw their bodies as ‘one joined entity’ and often built intense relationships. In this way, surrogates could distance themselves from their bellies and intended mothers could take up this bodily space as part of themselves. Throughout, Teman calls this ‘the shifting body’.

In the third part, ‘Separating’, Teman discusses the liminal, ambiguous phase after the birth, during which intended mothers and surrogates tried to figure out their roles. Here, the assumed reciprocal relationships between intended mothers and surrogates were tested, especially when intended mothers started to reframe surrogacy as consumption instead of acknowledging the ‘gift’ the surrogate gave them. In‘Redefining’, Teman writes that surrogates saw surrogacy as a ‘mission’, where they needed to overcome many obstacles (such as screening processes, waiting times, and IVF procedures) to prove their strength. Through this process, surrogates realized that they were making life (not just babies, but mothers and families), which they saw as the ‘highest level of service before G-d’ (p. 266). While their economic status rarely changed through surrogacy, their ‘mission’ gave them a chance to contribute to the nation and feel part of ‘divine creation’ (p. 280).

Teman wonderfully highlights the ‘local moral world(s)’ (Kleinman 1995) affecting how women navigate Israeli surrogacy, where ‘surrogacy is an emotional roller coaster ride in which one mother, through strategy and sacrifice, helps another woman to also become a mother’ (p. xx). It is not merely about ‘creating a baby’ or about individual experiences, but about the relationships and strategies between surrogates and intended mothers. Teman refreshingly shows a deeply personal side of surrogacy that often gets overlooked in debates and research on the topic.

I find Teman’s discussion of power and agency important to her quest to show the nuances of surrogacy instead of following the stereotypes. She carefully reveals that while surrogacy creates opportunities for agency in many ways, this agency still exists within a structure that values certain ways of reproducing and behaving for women. One could question if this is even agency, but this might not be the main question; rather it is: what do the people involved do and feel? Teman explains this very well, compellingly demonstrating that surrogacy is not solely top-down control of women and their bodies, but that women have bottom-up ways of navigating this process in sometimes surprising ways.

I think Teman could have paid more attention to the ‘stratified reproduction’ of surrogacy. This concept, originally from Colen (1986), refers to inequalities ‘by which some categories of people are empowered to nurture and reproduce, while others are disempowered’ (Ginsburg and Rapp 1995, 3). Teman uses the concept to explain how surrogates in Israel do mothering work without being labelled ‘mothers’, but I think the concept could be applied to Teman’s study in more relevant ways. While Teman stresses that surrogacy is not solely for the rich in Israel, I nevertheless think class plays a role. Teman states that ‘surrogates are expressly selected by the state for the very attributes that make them marginal’ (p. 230), such as being single mothers and having financial concerns. Though Teman states that intended mothers generally are not wealthy, it still seems that there is a class-based difference that is overlooked here, in who gets paid and who pays for surrogacy.

Another omission is the sidelining of men. Teman explains that intended fathers and partners of surrogates tend to be barely involved in the process, partly because of the intensive relationships surrogates and intended mothers build. Teman moreover states that the intended fathers saw surrogacy more as a commercial exchange than as a gift. This left me wondering how the men involved actually felt about the process, as surely it was a big change in their lives as well. Since Teman interviewed men, and looked at the role of gender for women involved, more attention should have been paid to men and masculinities in Israeli surrogacy.

Still, this is an important ethnography. Teman gives voice to the people actually involved in surrogacy, providing a nuanced perspective on the topic that is often missing. I would recommend reading this book, especially for those interested in the anthropology of reproduction, but also for those interested in medical anthropology, ethics, motherhood, or gender more broadly.

About the author

Maria Siermann is a graduate student in the Research Master’s in Social Sciences at the University of Amsterdam. Her main interests are medical anthropology and gender and sexuality studies. She is interested in the anthropology of reproduction, particularly related to assisted reproductive technologies with third-party involvement.

References

Colen, Shellee. 1986. ‘“With Respect and Feelings”: Voices of West Indian Child Care Workers in New York City’. In All American Women: Lines That Divide, Ties That Bind, edited by Johnnetta B. Cole, 46–70. New York: Free Press.

Ginsburg, Faye D., and Rayna Rapp. 1995. ‘Introduction: Conceiving the New World Order’. In Conceiving the New World Order: The Global Politics of Reproduction, edited by Faye D. Ginsburg and Rayna Rapp, 1–18. Berkeley: University of California Press.

Kleinman, Arthur. 1995. Writing at the Margin: Discourse between Anthropology and Medicine. Berkeley: University of California Press.