Ellen Goodman has a fascinating column in the Boston Globe about the international surrogacy business. She writes:

[T]here is — and there should be — something uncomfortable about a free-market approach to baby-making. It’s easier to accept surrogacy when it’s a gift from one woman to another. But we rarely see a rich woman become a surrogate for a poor family. Indeed, in Third World countries, some women sign these contracts with a fingerprint because they are illiterate.

For that matter, we have not yet had stories about the contract workers for whom pregnancy was a dangerous occupation, but we will. What obligation does a family that simply contracted for a child have to its birth mother? What control do — should — contractors have over their “employee’s” lives while incubating “their” children? What will we tell the offspring of this international trade?

I’ve been wrestling with this column for a few days now. On the one hand, I share Goodman’s uneasiness. Maybe it’s just the “yuck” reflex, but something seems wrong about paying a desperately poor woman to carry your child, espcially in “social surrogacy” cases. The entire thing just feels a little too much like The Handmaid’s Tale to me.

On the other hand, my uneasiness about international surrogacy seems a little…luxurious, in a way that reminds me of the moral handwringing over Third-World sweatshops. Most of the protests over these factories did very little to improve the lives of the people working in them, and served in many cases to actually make them worse off — all so some well-off Westerners don’t feel uneasy. (Needless to say, my inner libertarian is not happy with me.) One Indian surrogate used the money for her son’s heart operation. Another explained her decision thus: “This is not exploitation. Crushing glass for 15 hours a day is exploitation. The baby’s parents have given me a chance to make good marriages for my daughters.” Who am I to decide crushing glass is somehow less “degrading” or “exploitative” than carry another woman’s child? (For a similar argument, see Kerry Howley’s post about egg donation.)

Yet, I’m not wholly satisfied with the libertarian argument. Goodman says that we have not had any stories of a surrogacy pregnancy gone wrong, and she is right that the media hasn’t yet reported on any international cases that resulted in the death or near-death of a surrogate. But surrogacy can be a dangerous occupation, and too often women are not properly informed of the risks involved — as these two disquieting stories from Liza Mundy’s Everything Conceivable attests. In one case, the intended parents wanted twins so they asked their surrogate, Ann Nelson, to transfer four embryos. Only two of the embryos “took,” yet the twin pregancy put Nelson at increased risk for uterine rupture. She was also overweight and her prior pregnancies had been delivered by C-section. Despite these red flags, her doctor (independent of the agency) had cleared her to carry triplets. Nelson nearly hemorrhaged to death during labor, and her doctors had to perform an emergency hysterectomy to save her life. No one had informed the intended parents that this pregnancy might be risky, and even Nelson hadn’t realized she might die as a result.

A good agency (and an attorney!), of course, will help to navigate many of these pitfalls, but even in a situation, like Nelson’s, where no one was acting improperly, things can go wrong. My fear is that if American surrogates are often unaware of the risks involved, how can we ensure that women who are illiterate and desperately poor understand what they are getting into (and are not taken advantage of, as happened with these young Romanian women)? Which brings me right back where I started from…

RELATED: Stuart Rennie on “ready to consent” populations in Africa and India.