Pregnant Metaphors and Surrogate Meanings: Bringing the Ethnography of Pregnancy and Surrogacy into Conversation in Israel and Beyond

Abstract

This article explores the way that surrogacy and normal pregnancy share cultural assumptions about pregnancy. Through a juxtaposition of our ethnographic studies of two groups of Jewish–Israeli women—women who have undergone “normal,” low-risk pregnancies and women who have given birth as gestational surrogates— we argue that surrogacy and pregnancy emerge as potent metaphors for one another. Both pregnant women and surrogates divided their bodies into two separate realms: fetus and maternal pregnant body. Both trivialized the effect of gestational influence on fetal health, making the fetus seem detached from gestational capacities of the mother. We argue for closer scrutiny of the way local cultural priorities and experiences of pregnancy shape surrogacy and for bringing the scholarship on pregnancy and on surrogacy into deeper conversation.

Introduction

This article stems from a 15-year-long conversation about the connection between pregnancy and surrogacy in Israel and beyond. Although surrogacy has become a popular topic of ethnographic inquiry, there has been surprisingly little attention to how local cultures of pregnancy shape surrogates’ experiences in the same cultural milieu. Drawing on research about Israeli pregnancy and surrogacy as linked case studies, we argue that the features of normative Israeli pregnancy shape how surrogates navigate the emotional and embodied dimensions of surrogate pregnancy. Specifically, we describe Israeli cultural theories of procreation, embodied experiences of pregnancy, and emotional postures related to pregnancy that cross over between normal and surrogacy pregnancies. Whereas most literature treats pregnancy and surrogacy as separate phenomena, our exploration contributes to understanding how both are constituted vis-á-vis one another in local sociocultural and political settings. We begin by turning to an overview of the anthropology of reproduction scholarship, which, until now, has explored pregnancy and surrogacy as two separate spheres of inquiry.

Pregnancy and the Anthropology of Reproduction

Most of the rapidly expanding literature on the anthropology and sociology of reproduction is concerned with the way that women’s reproductive capacities are being mediated, manipulated, substituted, and bypassed by the new reproductive technologies. Indeed, the social scientific studies of human reproduction that emerged during the late 1980s were initiated in response to the growing availability and routinization of assisted conception, donor technologies and prenatal diagnosis—throughout the affluent West and beyond. Much of the international scholarship concentrates on the experiences of men and women trying to achieve conception through in vitro fertilization (IVF) (Bharadwaj 2006; Inhorn 2003; Roberts 2012; Thompson 2005).

Thus, for several decades, studies of the everyday, embodied, and emotional experiences of normative gestation have been surpassed by those focused on women’s encounters with reproductive technologies and medical interventions (see Morgan 1990). Our present inquiry is inspired by the work of Sarah Franklin, who has argued, together with Marilyn Strathern, that reproductive technologies are transforming our understandings of the facts of life and of nature and culture. Whereas IVF has been conceptualized in the public media as “giving nature a helping hand,” Franklin argues that the effect is bi-directional: technologically assisted conception is increasingly becoming the primary frame of reference from which “natural conception” is understood (Franklin 1998, 2013; Strathern 1992). In other words, spontaneous conception is increasingly being imagined as if it has occurred in a petri dish; both assisted and unassisted conception are understood as increasingly complicated processes with high failure rates.

It is with this focus on bi-directional imaginings that we realized that the ethnographic research on surrogacy and on pregnancy seems to have sprouted in different directions, as though they do not have important impacts on one another. There has been little consideration of pregnancy as a meaningful unit of ethnographic analysis, let alone as a primary focus of scholarly concern, even though the periods surrounding pregnancy—including infertility, reproductive technologies, and childbirth—have been widely explored (Ivry 2015). The few studies of normative pregnancy in industrial societies emphasize women’s experiences of somatic transformation into an unfamiliar body (Bailey 2001; Han 2014); the liminality of pregnancy in the public sphere (Longhurst 2001); and the ways in which liminality is managed through rituals of consumer culture (Han 2014). This article develops Ivry’s (2015) call in her “pregnancy manifesto” to bring pregnancy to the center of the anthropology of reproduction.

When feminist and anthropological studies of reproduction have discussed pregnancy over the past four decades, it has most often been with a focus on the effects of the transformative technologies that affect pregnancy, such as ultrasound. For instance, scholars working in Europe and the United States have claimed that obstetrical ultrasound imaging has replaced the realization of pregnancy through quickening (Duden 1993; Georges 1996). It has also been argued that the routinized use of sonograms is increasingly transforming fetuses into fully fledged patients, whose rights might conflict with the pregnant woman’s rights and which render women’s bodies increasingly permeable and transparent (Casper 1998; Mitchell 2001; Taylor 2008). Scholars documenting the routinization of prenatal diagnosis have shown how women’s experiences of normative pregnancy are increasingly complicated by technological screening for fetal anomalies. Amniocentesis has made pregnancy “tentative” (Rothman 1986) and pushes women who face post-diagnostic decisions about terminating their pregnancy to become “moral pioneers” (Ivry 2010; Rapp 1999).

Parallel to the scholarship on regular pregnancy but rarely in dialogue, the topic of surrogacy has received significant scholarly attention in the anthropology and sociology of reproduction. Radical feminist theorists of the 1980s–1990s advocated strongly against surrogacy, viewing it as a form of subordination and exploitation of women’s bodies under patriarchal technological regimes, comparable to prostitution and slavery (see, e.g., Corea 1985; Rowland 1992). As this scholarship gained traction, surrogacy became widely understood as erasing women’s subjectivity and turning surrogates and the babies they produce into objects to be bought and sold as commodities. Importantly, the scholarship on surrogacy has consistently differentiated surrogate pregnancies from normative pregnancies, framing surrogacy as an urgent bioethical problem.

The recent stream of ethnographic studies on surrogacy continue earlier ethnographically bound attempts to complicate our understanding of surrogacy beyond exploitation and commodification. While two recent studies have explored surrogacy in the United States (see Berend 2016; Jacobsen 2016), the most ethnographic attention has been focused on India (Deomampo 2016; Pande 2014; Rudrappa 2015; Vora 2012). The dominant theoretical orientation of both Jacobsen’s U.S. study as well as the Indian studies is the framing of surrogacy as work; a common argument is that surrogacy can be understood as paid “biological labor” as well as “emotional work.”

Vora (2012) discusses surrogacy as a new form of “biological and affective labor,” comparing it to another form of outsourced service work in the Indian labor market, namely, call center work. What these types of work have in common, Vora suggests, is the “labor of producing and transferring human vital energy directly to a consumer” (p. 682). Rudrappa (2015) suggests that surrogacy may offer the Indian women she interviewed better working conditions than those they encounter in the garment factories in Bangalore. Likewise, Pande (2014) creates an analogy between Indian surrogates and factory workers, emphasizing the construction of both as disciplined subjects and cheap global laborers, but adding to the surrogate’s docility the qualities of selflessness and nurturance that make her a “perfect mother worker.” She stresses the duality of the surrogate’s reproductive labor by pointing out not only the work of surrogacy but also the labor of childbirth.

While this new anthropological and sociological literature on surrogacy continues to challenge the notion of surrogates as predestined victims of exploitation by comparing surrogacy to other forms of outsourced labor, it rarely questions the singling out of surrogate pregnancy experiences as profoundly different from those of ordinary pregnancy. It seems that the division between paid and unpaid reproductive labor—echoing concordant divisions between unusual versus ordinary, unethical versus ethical, exploitative versus fair, artificial versus natural and finally exotic and requiring explanation versus taken for granted and uninteresting—has crept into the assumptions underlying the choice and design of the research apparatus and into the theoretical orientations of ethnographers of reproduction. As a result, scholars overlook the local cultures of pregnancy on which surrogate arrangements draw. We do not mean to dismiss the differences between paid and unpaid gestation, but to suggest that we cannot fully explore the former without bringing it into empirical conversation with normal gestation.

By exploring both pregnancy and surrogacy in Israel as bi-directional influences, paying close attention to the somatic modes of gestation of each, we hope to promote a deeper understanding of these reproductive practices and their interconnection.

Methodology

This article is based on two separate anthropological studies brought into conversation. Both studies were published as ethnographies, including the full methodology of each project (Ivry 2010; Teman 2010). Ivry’s comparative ethnography of pregnancy in Japan and Israel during the first decade of the 21st century was based on a multi-sited approach, including participant observation in Israeli birth preparation courses for expectant parents and at information fair “fun days” for pregnant women, as well as textual analysis of popular pregnancy literature. The study also included interviews with 20 Israeli women who were pregnant or had given birth recently about their pregnancy experiences and interviews with 20 Israeli obstetrician–gynaecologists.

Teman’s study of Israeli surrogacy arrangements also involved participant observation at birth celebrations, support group meetings for surrogates, observations of written exchanges on an online message board for surrogates and intended mothers [IMs] and at their in-person gatherings, and interviews with surrogates and IMs, fathers, and professionals involved in Israeli surrogacy. This article includes interview data from 43 interviews with 26 surrogates from Teman’s original ethnographic study in 1998–2006 as well as data from 20 additional interviews in summer 2016 with 20 surrogates who had given birth in the past two years.

The Jewish–Israeli “Tentative Pregnancy”

Regular pregnancy among Jewish Israeli mothers is marked by tentativeness, hesitancy to bond, and a worst-case scenario mentality. In Israel, a widespread local belief is that one should not assume that pregnancy will result in a live and healthy baby. Women are so nervous about possible failed pregnancies that they resist purchasing goods for their baby until after a successful birth. For instance, popular stores selling baby furniture invite expectant parents not to purchase on site, but to place orders for goods prior to the baby’s due date. Expectant parents put down a small deposit and leave the order at the store until they return home with their baby.

Women also maintain that one should not share the baby’s name or visibly prepare necessary equipment before birth. The impetus for these behaviors was complex, partly related to fears of tempting fate or the evil eye.

Pregnant Israeli women in this study, all of whom experienced normative low-risk pregnancies, all had some level of concern about birth outcome and corresponding tentativeness to some degree. Some women completely refrained from any preparations. Others, particularly second and third time mothers, developed strategies to enable them to prepare in a way that could retain the stance of unpreparedness. This was an ambiguous endeavor in the face of preeminent reproductive catastrophe. Aya, a pregnant educational psychologist in her 30s, raising a five-month-old at the time of interview, said:

When I was in my eighth month of pregnancy, I saw a pair of two wonderful bottles on sale at the supermarket. I wanted to buy them but I could not. So I phoned my friend and we agreed that she would buy them for me and keep them at her house until I give birth.

Carmela, a 33-year-old pregnant woman raising a three-year-old child, who grew up in Argentina and immigrated to Israel in her 20s, was perplexed when she mentioned the imperative of unpreparedness:

In Argentina, the room is ready for the baby beforehand. Everything! The bed and the sheets and everything. Here, nothing. Don’t open up the bed. It’s wrong. [If you make an order], everything should stay at the store. I live here so I’ve become integrated, but I don’t understand why preparing a bed for a baby is forbidden. … Maybe it brings bad luck? … Maybe this way you’ll be less disappointed? If you’re expecting the worst, then if nothing happens everything will be all right. I washed the [baby’s] clothes and put them in the drawers, but I won’t open the bed, that’s for sure; only the clothes. In the previous pregnancy I had a bed, but it was folded and I even had a mattress… . Some people, you know, wouldn’t dare even to do this.

Carmela narrates a pregnancy haunted by potential catastrophe. It takes a daring individual to contest this state of mind. Even Carmela, who referred to the cult of unpreparedness as superstitious and who was intimately acquainted with a different understanding of pregnancy, ultimately acquiesced to the norm and only resisted quietly.

Our point is that there is a particular script for normative pregnancy among Jewish Israeli women that derives from culture. This script can be compared with that found in other places. While many Japanese mothers already prepare baby clothes for their unborn babies from the fifth month (Ivry 2010), and American expectant mothers celebrate baby showers during the seventh month of pregnancy (Han 2014), Israeli pregnant women are too frightened to buy baby bottles even when delivery is rapidly approaching.

These notions of pregnancy as threatened by potential misfortune can be traced to many things. We will explore below how they are related to technological imperatives that make successful birth seem more and more unlikely. But we acknowledge that these patterns are also related to traditional cultural sentiments that date back many centuries before the advent of modern medicine. Specifically, they are related to Mediterranean ideas about the evil eye (a form of jealousy that can impinge on the health or well-being of the newborn and/or mother) and about the necessity to protect pregnant women from its harm. Similar folk beliefs are still found in European and Euro American Jewish communities (Teman 2008). The worst-case scenarios that these beliefs harken to echo a master script, in the Israeli case, of the existential threat to the nation-state (see Ivry 2010). We will not explore that in detail here. What we will explore is how the contemporary version of the pregnancy threatened by reproductive misfortune derives at least in some large part from the kind of prenatal care that is available in Israel and specifically from the advent of prenatal diagnosis of fetal anomalies. We will also explore how the detachment such tactics arouse relates to surrogate pregnancies.

Prenatal Diagnosis and the Fetal Suspect

Israeli pregnancy is structured in and through a series of prenatal tests for detecting fetal abnormalities; information about these tests permeates the Israeli public sphere with little bioethical public debate. The standard test basket includes a larger number of fetal screening options than are offered in European and U.S. prenatal health care systems. The Israeli routine includes testing late into pregnancy and is supported by a law legalizing abortions of fetuses diagnosed with anomalies, with no limit on the type of anomaly or gestational age at time of termination.

Israeli ob–gyns, fearing wrongful birth lawsuits (Mor 2014), tend to encourage women to undergo as many tests as possible, for their own peace of mind, while family and friends in nonreligious sectors pressure pregnant women to comply with this social norm. Every new test that is invented is quickly marketed, and doctors not only inform their patients about each new test, but some even accept women as patients only on the condition that they undergo these screenings, including invasive tests like amniocentesis that carry a risk of miscarriage. Israeli practitioners also claim that their detection rates are higher compared to their colleagues overseas. Rather than seeing this as an artefact of over-testing, however, they insist they have reached a higher level of expertise in diagnosis because of the proliferation of testing.

Thus, women who were experiencing normative, low-risk pregnancies often found themselves confronted with information about myriad reproductive misfortunes, with strong emphasis on the prospect of carrying a compromised fetus. The abundance of information on fetal abnormalities had a direct effect on couples’ attitudes toward the pregnancy. As Dr. Yaloom, a gynecologist at a major Israeli hospital, stated: “Couples come to me, so I tell them, ‘Listen, there is this test for cystic fibrosis, and that test for something else, and this and that …’ and I watch them and see how slowly the wind deflates from their sails and they were so excited about this baby.”

Dr. Yalum’s description of the devastation and disappointment of those who had wind in their sails but, after losing their confidence, become immobilized is typical. Far from empowering expectant parents, the information that couples are given regarding prenatal diagnosis has the power to dowse their spirit. Often arriving at the appointment with an already robust sense of fear about pregnancy outcomes,these encounters with physicians increase their sense of uncertainty. In fact, parents arriving with some hesitation about the certainty of a potential poor birth outcome are given multiple reasons to worry even more, extinguishing whatever enthusiasm they may have had. While some pregnant women may become engaged in an endless search for medical information, other women consciously minimized exposure to biomedical information for the sake of their emotional well-being. However, even the latter had to exert much effort to block the flood of anxiety-provoking information coming from their physicians that seemed to overwhelm them.

Whereas technologies such as obstetric ultrasound are theorized in Euro American and Canadian settings as enhancing fetal subjectivity (Mitchell 2001; Taylor 2008), in the Israeli context they seemed to undermine possible bonding effects. They were more often regarded apprehensively, as first-time mother-to-be Neta described: “We entered the darkened room, and the doctor did the ultrasound examination. He said, ‘Look, what a nice face this fetus has, let’s try to see what the sex of the fetus is.’ So my husband said, ‘First tell me if everything is okay and then tell us the sex.’”

Anticipating potential problems, Neta’s husband attempts to suspend fetal subjectivity in the face of its enhanced visibility. For him, the fear of fetal abnormalities is stronger than the potential bonding that this technology (and the doctor’s efforts) might arouse.

An ambiguous image of the “fetal suspect” arises from Israeli women’s accounts of their pregnancies. Thus, ironically, women may undergo frequent ultrasounds that could increase the sense of the reality of the impending newborn, yet these interventions do not seem to succeed in transforming a fetus into a person to the degree documented in Euro American contexts (see Casper 1998; Mitchell 2001; Taylor 2008). Aya, quoted above, said she asked her doctor to prescribe as many ultrasounds as he possibly could to appease her anxieties about fetal anomaly.

Tsipy: How did you feel about seeing your baby so often?

Aya: Well, what do you mean? The fetus? The ultrasound relaxed me, seeing the fetus, and being told that everything is okay, but I was too busy with the ongoing things of pregnancy. I did not let myself fantasize about the baby until very late, maybe the eighth month. I did not let myself think about how it is going to be. I am always so surprised at women who fantasize a lot during pregnancy. How dare they? So many things, so many accidents can happen.

While Aya was explicitly asked about her baby in the above quoted exchange, what Aya sees on the ultrasound screen is a fetus, still a remote entity and not yet an actual baby. The enhanced visibility of the fetus does not enable Aya to connect emotionally to her fetus. Instead, Aya is informed by a grammar of thinking that presupposes the preeminence of a reproductive catastrophe. Aya continued:

I think I had mixed feelings, a mixture of excitement on the one hand and on the other hand a very big fear. Should I be happy and hope? Could I allow myself to expect too much? Because of my work, I know about all kinds of syndromes in children, and all kinds of problems, so I did not let myself fantasize about how all this (having a baby) was going to be.

Aya’s story reveals a hesitant bonding that is directly linked to her negotiations with the notion of impending reproductive catastrophe. Formulated from the time of inception as an entity that needs to be tested, scrutinized, and peered at before it can be deemed worthy of acceptance, the Israeli unborn emerges not so much as a baby but rather as a suspect of investigation. This is reflected in Hebrew-language pregnancy guides that refer to a fetus using the word ubar from the Hebrew root word meaning passing or transience; the fetus does not become a baby up to the last trimester of pregnancy, often only after it is born. It is, up until that time, only a passing or transient possibility.

Geneticism, Trivialization, and the Divided Pregnancy

The basic stance of Israeli pregnancy is one of acute tentativeness that promotes emotional distance from the fetus until it is born as a baby. The worst-case scenario mind-set (in which it is assumed that if something bad can happen it probably will) leads to both a suspension of prenatal bonding and to a vision of pregnancy as consisting of two separate entities: the fetus and the maternal pregnant body, with far-reaching implications for pregnancy outcomes. While the fetus is screened, tested, and investigated for inborn anomalies based on the assumption that genes and chromosomes determine fetal health, there is relatively little attention to the contribution of the maternal body to fetal health. Much epidemiological data, particularly in the field of “fetal origins of adult disease,” point at the importance of intrauterine conditions created in part through maternal nutrition. However, Israeli medical discourse generally tends to overlook gestational influence on fetal health, leading to a marginalization of factors such as women’s nutrition and physical activity during pregnancy by medical practitioners and pregnant women alike.

Israeli medical practitioners never skipped a discussion of a long list of prenatal diagnostic tests with their patients regardless of the patient’s age, yet they rarely discussed the mother’s management of her own health in relation to her pregnancy. Nutrition was not discussed with women whose pregnancies were categorized as low risk, nor did they discuss measures to prevent excessive weight gain, despite the fact that weight gain can have far-reaching effects on the well-being of women during pregnancy and cause complicated deliveries. Israeli women, terrorized by the specter of anomalous fetuses, were pushed toward performing responsible motherhood via selective technologies. Simultaneously, they were relatively slow to interpret pain and discomfort during gestation as having anything to do with fetal well-being, attempting not to make a fuss over physical challenges of gestation. One interviewee experienced pain for several days before seeing a doctor; after her doctor prescribed bed rest as a preventive measure against pre-term birth, she dismissed the idea that this was a serious medical condition, returned to her job and worked until the end of her pregnancy.

Mira, a 27-year-old graphic designer, told of an ordeal that started in her fourth month of pregnancy, when her doctor prescribed iron pills. In hindsight, it became clear to her that these pills gradually caused her to dehydrate, which she believed eventually led to preterm labor. This complication happened slowly, developing over a month of suffering, during which Mira complained of not being able to eat and drink and of continuous diarrhea. She went to seek the advice of her doctor, who merely told her that her symptoms were “natural effects that happen during pregnancy.” Although she felt strongly that something was clearly wrong, her family, and her female relatives in particular, all of whom had experienced pregnancy and birth, discouraged her from becoming alarmed at her sensations. Her mother, grandmother, and aunts said that “This is natural; it’s because of the pregnancy. You’ll see, you’ll suffer from these symptoms until the end of your pregnancy.”

Mira is only one of several women who developed a sort of heroic deafness toward their bodily sensations that enabled them, at least temporarily, to carry on with their daily tasks and to fulfill their work commitments, despite pain and discomfort, in the belief that their own health state had nothing to do with fetal well-being or the possibility of successful delivery. The extraordinary separation of their own pregnancy from that of their fetus was often affirmed by the fact that the diagnostics used to test fetal well-being often attended to fetal indicators while ignoring (or downplaying) maternal health.

In Israel, women’s bodies were regarded as considerably less relevant to fetal health, and gestational labor was trivialized as much less influential than things like fetal genes and chromosomes. At the same time, Israeli women were expected to continue fulfilling their commitments to their paid jobs until the end of their pregnancy. The notion that actual labor could affect fetal health was also not considered. In other words, Israeli theories of procreation suggest that mothers play a minimal if any role in ensuring or improving fetal health other than in getting the right fetal tests. One consequence of this assumption was the corollary belief that the only way to select or ensure healthy babies was to use technologies to help select who was allowed to be born.

A geneticist vision of gestation (Ivry 2010) could be seen in this context, in which the pregnant body was seen as a receptacle for a baby whose fate was predetermined, a ready-made baby whose capacity for health was determined by fetal technologies. At its extreme, this model denied women maternal agency, with implications for women’s embodied experiences of pregnancy that were far-reaching. Some Israeli women vocally resisted the specter of genetic fatalism by trying to foster a relationship with the fetus through nuanced attention to the various qualities of fetal movements, such as kicking. Others resisted such attachments vociferously, focusing wholly on the script of threatening catastrophe and consciously working to ignore somatic sensations that attested to the existence of a living being within them. This produced a “divided pregnancy.” Ora, a 34-year-old mother of a 10-year-old child, interviewed during her second pregnancy, described her denial of somatic sensations eloquently:

Ora: I did not become attached to this pregnancy from the beginning. I felt him moving very early in the pregnancy, as early as the third month, but I ignored it. I said, “I don’t want to feel anything. I want nothing. I want to know that everything is O.K. and then … maybe.”

Tsipy: What do you mean exactly by “I did not become attached”?

Ora: The simplest thing. If I felt a movement, I ignored it, I felt nothing. It was just a muscle that moved. … I said, “I feel nothing,” because if they told me to abort, that is, if they told me that the fetus had a terrible disease and I have to abort it, what then?

Ora speaks of an attempt to detach herself from the fetus. This detachment is a familiar “emotional posture” (Ivry 2010) that women become skilled at during pregnancy, a social resource that is readily available for use. It is a defensive strategy that supposedly helps keep mothers immune from unpleasant surprises, so that should catastrophe befall them unexpectedly, they will not be devastated.

In summary, Israeli cultural scripts for pregnancy create a possibility to separate the fetus from the maternal experience. These scripts are derived from fears of unsuccessful birth that are, in turn, aroused by the tragic confluence of traditional suspicions (like evil eye) with overuse of fetal diagnostic technologies that make every possible defect of the fetus visible. As a result, mothers experiencing normal pregnancies may approach bonding with the fetus with much caution and sometimes develop an outright detachment from their gestating offspring. In the next section, we explore how Israeli surrogates draw on this cultural script and on these techniques of detachment that, brought to an extreme, divided the pregnancy in order to navigate the surrogacy arrangement.

Israeli Cultural Scripts for Surrogacy

The culturally scripted pregnancy outlined above serves as a cultural toolkit on which surrogates draw in their navigation of the emotional and embodied complexities of surrogacy. We argue that genetic fatalism, trivialization of pregnancy, the embodied posture of divided pregnancy, and the emotional hesitancy to bond with the fetus all become particularly useful ground for surrogates to make their pregnancy culturally palatable. Surrogacy fits almost seamlessly with the way pregnancy is conceptualized; in fact, it forms the practical realization or somatic materialization of the core elements of Israeli pregnancy.

Let us begin with the genetic fatalism of normative pregnancy in Israel. Just as the future health of a baby is believed to be predetermined by its DNA, so is fetal identity and belonging understood as fated from the start by Israeli surrogates. Not surprisingly, surrogates viewed the egg and the sperm used to create the embryo as inalienably associated with the personhood, the individuated self, the kin line, and the expected parenthood of their originators. In contrast, their womb, body, and the environment in which the fetus was gestated were thought to have no personalizing effect on the embryo’s genetic fate. This extension and interpretation of genetic fatalism enabled surrogates to both explain their role to others and have their own explanations make cultural sense. Maya, for instance, recalled showing a photo of the twins she birthed to an acquaintance. When the acquaintance noted how the babies did not resemble her at all, hinting that she thought gestation might have some impact on the babies’ likeness, Maya quickly corrected her, explaining that her womb had no effect at all on the babies: “I said ‘Honey, it doesn’t transfer through the belly. Genes are genes. It has no connection to me.’ That is the first question I am asked, if it is my egg. No way, they are not my children. There is no way I would do that. That (using my eggs) would make them my children.”

Like Maya, Israeli surrogates were quick to emphasize that the baby they carried for their couple was not “created from me,” “is a stranger,” “is not mine.” They were particularly adamant in stressing that the baby did not share “their blood” and were nearly all horrified by the idea of traditional surrogacy, which they believed would be “giving away my own child.” Thus, even though they literally did share blood with the fetus, they described their distance from the fetus by referring to blood as a term for lineage rather than actual blood. The dominance of this geneticist cultural script among Israeli surrogates could be contrasted with that of others, such as those described by Berend (2016) for U.S. women. In her study, surrogates also believed that gestating the surrogate baby did not make it their own, but they were also much less likely to claim their distance from the baby based on genetics. Instead, the U.S. surrogates in Berend’s study believed that desire for and intentions to create the child were firmer basis of parenthood than DNA or gestation.

For Israeli surrogates, intention could not fully replace genetics. Even in cases where an anonymous egg donor had supplied the female gamete, meaning that the IM did not have a genetic connection to the baby, surrogates worried that the IM might not bond with the baby. Zohar admitted that she had harbored such worries and was relieved when she saw the IM following the birth: “Look, in a certain way it is not her baby. She doesn’t carry the baby and it is also egg donation. There is no connection to her. But from what I saw afterwards, she was the most connected ever in the world.”

In addition to genetic fatalism, surrogates also trivialized gestation to downplay their part in creating the baby, yet here, too, a particular version of trivialization was evident. On the one hand, surrogates trivialized their gestational efforts by constructing their womb metaphorically as an instrumental receptacle that could have been replaced by another woman’s womb with the same fated result. At the same time, they worried about the need to show how suitable that receptacle was by stressing their responsibility, caring, and domestication of their body. Maayan, for instance, spoke of how trustworthy she was in her personal care of her womb, and how her intended parents could trust her because of her integrity. Still, in the same breath she said: “My body is an awesome vessel for children.” Other women used receptacle metaphors that were notably associated with warming, baking, and feeding, as Einat said: “I always say that it is like an oven. The ingredients are already mixed. You just put the dough in and heat it until it becomes bread.”

The most common expression of this simultaneous trivialization of gestation while emphasizing the responsibility, warmness, and trustworthiness of the surrogate herself was in the popular comparison surrogates made to babysitting. Most surrogates explained their role to their children through this metaphor, using the Hebrew idiom shomeret, which implies babysitting as well as guarding over the fetus. Many surrogates told their children that just like a child being watched over by a babysitter, this baby would go home to its parents after the birth. This justified various feelings and called for statements of detachment from the infant they had “baked.” Sivan drew on the metaphor of hosting to explain her emotional distance from the baby:

I would correct people who would ask me “How will you part from, how will you hand over, how will you give away the baby?” It was important for me to say that I am not parting from or handing over or whatever. I am returning something that does not belong to me. … I am hosting something that does not belong to me, it is not mine at any stage. I am a hostess and there was no emotional connection.

Likewise, Liat spoke of the way she mentally disconnected and emotionally distanced the fetus to prevent bonding, suggesting that this was an emotional and embodied position she was familiar with before surrogacy:

I didn’t bond. I didn’t feel any sort of connection. I knew she wasn’t mine throughout the pregnancy, so I had no reason to become attached to her. Yes, I took care of her in order to make sure she received everything she needed to get nutritionally in the womb, but I knew she wasn’t mine and didn’t bond. I am very rational, I have an ability to disconnect. I know how to do it, it’s in the head and the emotions don’t have any influence. I do love the baby, of course, but like an aunt. She isn’t my baby, I don’t feel like she is my daughter.

The Divided Pregnancy and Intended Worrying

Let us now turn to the embodied posture of the divided pregnancy. We saw above that normal pregnancy entails separating the fetus from the pregnancy experience, demonstrated in mothers’ reluctance to connect their own health to that of their fetuses. Interestingly, surrogates did not adopt this embodied posture in the same way because of their own fears of the worst-case scenario. While they took great pains to ensure their own wombs were healthy, they believed it was the IM’s role to worry about fetal outcome and not theirs.

The way in which surrogates learned to divide their body in relation to the care of their womb, but not the fetus, led to interesting mental gymnastics around attachment. While some surrogates discussed the division of the pregnancy as something that came to them intuitively, others spoke of a conscious effort to distance and detach. Orna drew lines of separation on her body to distance herself from the fetus she carried:

So I was like this. Me [points to her chest and above], not me [indicates area from chest to mid-thigh]. Completely disconnected. I totally disconnected myself from the stomach. I mean, whatever I felt in my stomach, I didn’t feel. I mean, I was always saying that I am divided in three. From here to here is me, from here to here isn’t me, from here to here is me.

Dividing and distancing the fetus also drew on an additional similarity between normative Israeli pregnancy and surrogacy: the emphasis on medicalization,prenatal testing, and ultrasounds. Many surrogates viewed ultrasound appointments as strengthening their distance from the fetus, as Batya said:

Even in the ultrasound, I wouldn’t look. He [the doctor] would say to me, he is in such and such week … she has a girl… . I didn’t connect at all. Not at all… . I would look to the side… . It didn’t interest me … because I said that it is just a fetus that I won’t have in the end… . I knew that it wouldn’t stay with me in the end. And that it wouldn’t be part of me. So why become connected to it?

For other surrogates, being accompanied by their IPs to the frequent ultrasounds, medical check-ups, and prenatal tests enabled them to witness the IPs becoming parents while simultaneously strengthening their own distance from them. Carrine relayed:

They accompanied me to the nuchal translucency test, to the first anatomy scan and to the second anatomy scan. … it was very moving. Very, really. It was to see them … for the first time this couple is experiencing a pregnancy and seeing a fetus on an ultrasound monitor, it was so touching. During the first anatomy scan they told them it was a girl and they were even happier because that is what they wanted … to lay on the bed when the doctor is treating you and from the side to see the parents standing there and looking at the television monitor with such wonder at every little thing they see there: the nose, the lips, it was incredible. Suddenly you see their eyes fill with tears from excitement and it just really did me good.

Finally, it must be noted that the cultural script of uncertainty and of worrying that often accompanied prenatal tests in normative pregnancy was not absent in the surrogacy pregnancy, even though surrogates seldom expressed worry about worst-case scenarios themselves during their surrogacy. Instead, again, surrogates spoke of their IM taking on this worry, which they viewed as yet another sign that this was the IM’s pregnancy, and not theirs. Zohar recalled:

She (the IM) was very, very worried. I remember that once I had some bleeding. “You are bleeding because I went to see car seats yesterday. That’s why you are bleeding. I have given myself the evil eye.” Or “You feel that way because I told someone (about surrogacy) yesterday and they must have given me the evil eye.” She worried the whole pregnancy. She didn’t believe that it would turn out alright… that at the end of the process she would be a mom. She was very skeptical.

Sounding much like normatively pregnant women in Israel, the IM performed the cultural script of the expectant mother waiting for catastrophe to strike. Most of the IMs described partaking in the associated rituals of unpreparedness: not preparing the future baby’s room, not sharing the name, and even keeping the pregnancy secret until a very late stage of surrogacy for fear that even sharing the good news might cause something to go wrong. Sima, a surrogate, expressed her concern four months into the pregnancy that the divided pregnancy had resulted in both she and the IM distancing themselves from the twin fetuses, each because of her own set of concerns: “I told her what a strange situation this was. That I was trying so hard to ignore my stomach and she was keeping her distance. No one was bonding with them (the twins she carried). No one was touching, talking to them.”

Discussion: The Cross-fertilization of Studies of Pregnancy and Surrogacy

What can we learn from this juxtaposition of women’s experiences of regular pregnancy and surrogacy? Our answer is that the insights here speak to both how local contemporary Jewish–Israeli culture shapes pregnancy of any sort and to the assumptions underlying much of the scholarship on the anthropology of reproduction.

At the level of contemporary Jewish–Israeli culture, we have shown that local ideas shaping pregnancy constitute the grounds for surrogates to make sense of their experience. Surrogates draw on the cultural script of regular pregnancy to construct their detachment from the fetus and distance the pregnancy. In many ways, this script perhaps makes surrogacy in Israel more culturally palatable than in other places, where enormous weight is placed on the role of the gestational mother in bonding with (and producing) a healthy baby. The Israeli geneticized understanding of procreation—with its tendency to disregard the contribution of the gestational process to the making of the fetus, rendering women’s bodies as merely receptacles of ready-made unborn babies—lends itself particularly well to gestational surrogacy. However, while it would be tempting to analyze the cross-references between regular pregnancy and surrogacy as a phenomenon particular to the Jewish–Israeli setting, we argue that such cross-references deserve serious consideration beyond the Israeli case.

Specifically, studying the relationships between surrogacy and normal pregnancy may be fruitful in helping us reconsider the abundant scholarship on transnational surrogacy in India, with due attention to local cultures of pregnancy. We must consider that the women who travel from villages to the different Indian cities to become surrogates do not conceptualize pregnancy completely anew just because they are surrogates and are trained or coached to see their pregnancy as work. Instead, it is pertinent to consider that they have experienced their previous pregnancies in local cultural arenas in which pregnant bodies are conceptualized and treated in culturally specific ways, in which mythological and spiritual and even astrological beliefs may matter, and where local folklore, language, metaphor, and stories, as well as myriad other factors, give pregnancy a particular flavor.

Distinct cultural scripts of pregnancy are obviously at work everywhere. In fact, local theories of procreation and beliefs about the making of kinship ties, reproductive metaphors, and practices and rituals of pregnancy and birth emerge sporadically in the background of most surrogacy studies; we encourage more work be done on surrogacy from this perspective in India. Pande (2014), for instance, quotes surrogates talking about the blood, sweat, and tears shed during surrogate gestation, and could shed light on these quotes by exploring whether the particular women she quotes are drawing from a local set of pregnancy-related beliefs in the villages they migrated from to become surrogates in Anand. Similarly, Deomampo (2016) looks at the restrictive surveillance, immobility, and compulsory docility of surrogates temporarily housed in rented apartments away from their homes; it would be fruitful to explore the local pregnancy paradigms that the women are comparing their surrogate embodiment to in order to contextualize and further understand their experiences of surrogate embodiment. Rudrappa (2015) pays close attention to the differences in kinship networks, including ideas regarding child sharing, among Bangalore surrogates. Here too, we encourage exploration of the roots of surrogates’ conceptualizations of the pregnancy in the context of local understandings of pregnancy in the villages from which surrogates originate. The U.S. studies (Berend 2016; Jacobsen 2016) may reveal further layers of meaning from making such connections as well to local ideas and cultural scripts of regular pregnancy, such as those explored by Han (2014).

What we are calling for is greater attention to the embodiment of culture in relation to how normal pregnancy shapes surrogacy. Do different cultural theories of procreation differentially impact women’s somatic and emotional contribution to gestation and to the making of the new human being? Or are pregnant women already seeing themselves as receptacles of ready-made babies? How do incongruences influence surrogates’ embodied experiences of gestation? If surrogacy is discussed as a unit of analysis completely separate from normative pregnancy, then the cultural conceptions that shape it are eclipsed.

An additional array of important questions may come to mind when rethinking surrogacy through the literature on pregnancy and prenatal testing. There is little consideration of the implications of prenatal diagnosis and ultrasound in the experiences of surrogates and IPs involved in these arrangements. This is despite the centrality of these technologies in the anthropology of reproduction scholarship on non-surrogate pregnancy, and despite some discussion of the outcomes, both financially and emotionally, for surrogates who undergo pregnancy termination following positive diagnosis of fetal anomalies (see, e.g., Berend 2016). This splitting of the scholarship on surrogacy and on regular pregnancy makes it seem as though ultrasound has profound effects solely in the context of normative pregnancies and prenatal diagnosis only makes regular pregnant women into what Rapp (1999:3) calls “moral pioneers.” Yet the technologies and risks of prenatal diagnosis are not absent in surrogate pregnancies, and we encourage looking at the experiences and understandings of surrogacy participants regarding prenatal diagnosis and the discovery of fetal anomalies.

Conclusion

In line with our contention that it is only by considering the influence of normative pregnancy that we can comprehend surrogate gestation, we applaud Franklin’s (2013) call for a bi-directional approach to comprehending how pregnancy is changing in the age of surrogacy. We have argued that in Israel, understanding surrogacy is only possible by recognizing it as an extension of or at least in conversation with normal pregnancy. As a final insight from this analysis, we want to raise a question about how the scholarship on pregnancy could be enriched by looking at regular gestation through insights gained from the surrogacy scholarship. How do women articulate their experiences of normal pregnancy in the age of surrogacy? Are women increasingly articulating regular, non-contract pregnancy, as a form of affective, biological, and emotional labor as contract pregnancy becomes more mainstream? What are the effects of these increasingly evident frames of conceptualizing paid gestation—in terms of commodification, gifts, and reciprocation—on the way women articulate their understandings and experiences of normal, unpaid gestation?

It remains true, at the beginning of the third millennium, that any living human being will have been gestated for some months inside a woman’s body. Not even test-tube babies are actually gestated in test tubes, and women’s reproductive labor is still required for humans to come into being. Regardless of how it is culturally conceptualized, pregnancy is never just a matter of expecting a drama of waiting for the birth to come. Pregnancy is a mentally and physically demanding way of being, and often an energy-consuming project of meaning making; it is “pregnant with meaning” and a key site for understanding wider dimensions of the embodiment of culture.

Let us clarify that when we advocate for closer attention to local cultures it is not to insinuate the notion of culture—as an insular entity—held by classical anthropologists. Rather, we suggest a fine tuning between considerations of local and global modes of meaning making as well as local and global modes of subsistence, production, consumption, and the moral economies they entangle. When we advocate for greater attention to ordinary pregnancies, we are suggesting a finer balance between studies of exotic high-tech transnational reproductive practices and studies of the less exotic but widespread, long-term, demanding, somatic, and emotional gestational effort required to bring new human beings into the world. Only by understanding the embodied and affective experience of everyday local pregnancy can we attempt to comprehend the experience of surrogates in single cultures and as they are occurring cross-culturally. The case of Israeli pregnancy, whether normal or surrogate, is a nice place to start.