6 HEALTH & SCIENCE S U N D A Y, A P R I L 4 , 2 0 1 0 THE JERUSALEM POST

Womb to let
An Israeli anthropologist declares that the 1996 Surrogacy Law,
which helps couples unable to produce children to be parents,
is a success despite fears. Judy Siegel-Itzkovich reports
ly deciding to devote eight years to inter- sexual and married, with the written
viewing many of the surrogates and agreement approved by a Health
“intended mothers.” Ministry committee and recog-
Her book is the result of 43 in- nized by a court. No Muslim or
depth, formal conversations Christian Arabs have been

S
ince Israel’s pathfinding surrogacy law – the first in
which government supervises women being paid
to gestate the embryos and deliver the babies of
couples unable to have their own – was passed in
1996, about 350 children have been born. A few heart-
warming stories about childless couples becoming par-
ents and some sensational ones about surrogates who
regretted their role have hit the media, but there has
been no objective assessment of how the law has been
implemented and how it affected those involved.
At least until now. A comprehensive, 361-page, Eng-
lish-language masterpiece on surrogacy by an Israeli
social anthropologist, Dr. Elly Teman, has just been
published by the University of California Press
(www.ucpress.edu/books/pages/11401.php). Academic
and well-researched, moving and sensitive, Birthing a
Mother: The Surrogate Body and the Pregnant Self con-
cludes that the law was well designed and is being fair-
ly implemented.
Around the world, some feminists have denounced
surrogacy for allegedly taking advantage of the women
who bear the babies, while others have claimed it is
“abnormal” for a surrogate to forgo a baby she carried,
even if it was not her biological child.
Although Teman writes in the world’s first “ethno-
graphic study” on the subject that “surrogacy does have
the potential to exploit women..., the voices of surro-
gates counter automatic presumptions of exploitation by
showing that a majority achieve a degree of appreciation
through surrogacy that they do not get otherwise from
partners or from society at large.”
At the same time, despite fears of opponents, Teman
found that surrogacy arrangements in Israel did noth-
ing to erode the nuclear family; instead, it reflected
Israel’s conservative approach to reproduction and
reflected the pro-birth ideology of a mostly Jewish
society facing dangerous enemies.
Teman, who was born in Brooklyn, New York and
raised in Portland, Oregon, was brought to Israel as a
teenager. After completing her military service and
traveling in the Far East, she began her studies at the
Hebrew University, where she completed a doctorate
in social anthropology.
SHE FIRST became interested in the topic about two
years after the law was passed, and soon after the deliv-
ery at Haifa’s Rambam Medical Center of the first surro-
gate children – girl and boy twins – in February 1998. As
a graduate student in anthropology, she worked as an
interpreter for visiting US law Prof. Kelly Weisberg, who
came to Hebrew University to do research about her own
book, The Birth of Surrogacy in Israel. One day, Teman
accompanied Weisberg to an interview with “Yael,” who
as a woman who could not carry her own embryos to
delivery lobbied for the law; she and her husband later
contracted a single woman to carry their baby. Teman
writes in her book ($55 hardcover/$22 softcover) that
although she had never given such a situation much
thought, she was “profoundly touched” by Yael’s per-
sonal story and became good friends with her, ultimate-
with 26 surrogates and 45
interviews with 35 intended
mothers; most of these
encounters took place in
the interviewees’ homes,
and often included look-
ing at home videos and
photo albums. In some
cases, she spoke to both
the surrogate and the
woman who was to take
home the baby. She was also
in touch with some of the
intended mothers and surro-
gates during the pregnancy and
after the births, and in contact in
person or by e-mail with “two-thirds”
of those involved in Israeli surrogacy
arrangements between 1998 and the end of
2005. The academic nature of the work is demonstrated
by her 60 pages of notes and bibliography.
Teman and her husband Avi currently live in Philadel-
phia with their two children, Uriel and Rachela, while
she is working as a research fellow at the Penn Center for
Integration of Genetic Healthcare Technologies at the
University of Pennsylvania. They intend to return home
to Israel after concluding her postdoctoral work.
CONTRARY TO the image of surrogates as being desper-
ate women who undergo the implantation of embryos
of a couple just for the roughly $25,000 payment, Teman
found that about 30 percent were Israeli middle-to
lower-middle-class who worked at a steady job, owned
cars and lived in pleasant homes. They usually lived with
boyfriends and decided to be a surrogate to provide
“extras” for their family. About half were lower-class sin-
gle parents, divorced, widowed or never married, who
thought the money would give them a “financial push
forward.” The rest, said the author, lived in delapidated
apartments in poor areas and thought surrogacy would
be a better way to pay their bills than, say, selling a kid-
ney. Teman said the economic and class differences
between Israeli surrogates and intended mothers were
quite a bit smaller than their counterparts in the US,
where surrogacy is arranged privately and for much
higher sums. The would-be surrogate must be currently
unmarried, have at least one child of her own, must not
have miscarried or delivered prematurely, and be free of
psychological or physical problems.
UNLIKE COMMERCIAL arrangements in other countries
where surrogacy is not illegal, the intended mothers are
not rich career women who want children but don’t
want to be bothered (or become “misshapen”) by preg-
nancy. All of them have undergone many failed in-vitro
fertilization (IVF) cycles, miscarried many times and
were born without or lost their uterus due to disease.
Some had no healthy ova of their own and had to obtain
donor eggs to be fertilized by their husbands’ sperm.
Under the law, all intended parents have to be hetero-
surrogates or intended par-
ents, as Islamic law pro-
hibits surrogacy, and
strong stigmas surround
the practice in the Chris-
tian Arab community,
Teman writes. However,
a homosexual couple
recently petitioned the
High Court to give the
Knesset the authority to
allow them to apply as well.
The contract worked out
by the two parties includes
many details, possibly includ-
ing whether the surrogate can
(Tsipora Ivry) work or smoke, and what she may
not eat or do during the pregnancy,
what happens if she miscarries or the baby is born
defective, how she is paid, and other important details.
While the pre-surrogacy supervision is stringent, the
state avoids intervention during most of the pregnancy.
But at delivery (either vaginal or in many cases by cesare-
an section), the baby is whisked off and given to the
intended mother (who sometimes is hospitalized in the
maternity ward) and her husband, while the surrogate is
rolled into the gynecology department until her dis-
charge. The baby immediately and officially becomes the
natural child of the couple (who like the surrogate
receive a maternity allowance) and is entered into their
identity cards.
Teman stresses that while the Orthodox religious
establishment in Israel might have been expected to
fight legal surrogacy, opposition was overcome by
Judaism’s highly positive views of having children
and using almost any means to achieve this. Added to
this imperative is Israel’s national culture of increas-
ing the population.
Surrogacy and taking home one’s biological baby are
described by many participants interviewed as powerful
experiences that change lives. “And that’s why I say, I
didn’t just give birth to a baby; I gave birth to a mother,”
declares Tamar, a surrogate, even before the volume’s
text begins. “I always say my mother gave birth to me
the first time; she gave me life. But my surrogate gave me
life the second time,” says Shlomit, an intended mother.
The IVF procedure and embryo transfer are quite com-
plicated, requiring a series of rather painful hormone
shots in the buttocks of the biological mother to ripen
her ova, which are fertilized in a glass dish by her hus-
band’s sperm. The surrogate too undergoes shots to coor-
dinate her reproductive system with that of the biologi-
cal mother so her uterus will be maximally prepared to
receive the embryo(s).
IN A VERY interesting chapter, the author explains that
the surrogates she interviewed have a different vocabu-
lary and use special metaphors for parts of their bodies to
separate themselves from the commissioning couples’
fetuses. One called herself an “oven that bakes the bread
DR. ELLY TEMAN
for hungry people. I just help them... Like if my friend
needed a loan, I would save from my own food, and I
would give her a loan. Would they then say I am being
used?” Another surrogate said she was “someone with a
womb, a good womb ... I just held [the fetuses] in my
belly, like an incubator... I was their incubator for nine
months... And the second that they were born, I finished
the job and that was it.”
Many of the surrogates described their commissioned
pregnancy as very different physically from when they
bore their own child – little or no nausea or food urges,
for example. It was as if their womb belonged to someone
else, and their emotions toward the fetus were nonexist-
ent. In no case did any surrogate chronicled by Teman
express a desire to keep the baby they had delivered.
The relationships between surrogates and intended
parents were often very close, especially between the
women. Some said they would do anything for the bio-
logical mother and felt the need to update her daily on
what she felt so that the mother – who could never
become pregnant – would be able to “experience” it.
Some of the commissioning mothers developed symp-
toms of pregnancy – even high levels of pregnancy hor-
mones – as a way of entering their future role. They
invariably fondle the belly of their surrogate to feel fetal
movements and hear the heartbeats and drive the surro-
gates to tests and spoil them. Sometimes even the father
is allowed by the surrogate to be present for vaginal ultra-
sound scans, not to mention the birth. But in some
cases, the relationship becomes very sticky, and Teman
describes cases in which the couples develop severe psy-
chological dependence and make too many demands,
forgetting the boundaries of the surrogate’s self. Yet some
surrogates also worry about the sudden disconnection
from the couple, fearing they will lose them as friends.
Surrogate e-mail forums and Web sites often carry such
stories and give advice to avoid the minefields.
Teman notes that the law has its drawbacks, including
the directive that surrogates must be single women, that
gay couples and single persons cannot hire surrogates,
and that intended mothers must first have made repeat-
ed IVF attempts to prove their candidacy. “However, the
legislation also protects surrogates, couples and the
resultant child. The government ensures that parties are
diligently screened and that all contracts are valid.” It is
the quality of the surrogate’s relationship with the cou-
ple that largely determines her satisfaction with the
experience. The Israeli surrogacy law, minus some of the
restrictions required by Jewish law, could serve as a
model for other countries, the author concludes.

HEALTH SCAN NEW WORLDS

• By JUDY SIEGEL-ITZKOVICH • By JUDY SIEGEL-ITZKOVICH

Bone density gene Israeli scientists helping Egyptians save

A
defective gene that helps
explain why its bearers lose
bone density has been dis-
covered by researchers at Ben-
cations that caused death in
infancy, but the Beersheba
researchers found no such prob-
lems in their Beduin patients.
osteoporosis. The drug is based
on the small molecule MK-
5442, which inhibits calcium-
small Nile fish from hungry Nile Perch
sensing receptions on the thy-

Gurion University of the Negev
and Soroka University Medical
Center in Beersheba. Prof. Eli
Hershkovitz, Dr. Neta Leventhal
and colleagues published their
research in the American Journal
of Human Genetics.
Studying rare, extreme forms
of common disease lays the
foundation for identifying the
mechanisms that underlie the
more common forms, they note.
Studies in rare bone diseases with
an inheritance pattern that can
be attributed to a defect in a sin-
gle gene have proven their
potential for identifying several
previously unknown genes that
play key roles in regulating bone
mass and bone turnover.
Their team studied a large
Beduin family of married first
cousins with cases of hypophos-
phatemic rickets (soft bones due
to loss of phosphates). Further
research by Prof. Ruti Parvari of
the department of developmen-
tal genetics and virology and
National Institute of Biotechnol-
ogy in the Negev by master’s
degree student Luba Avizov
found on what chromosome the
gene is located. Dr. Varda Levi-
Litan, a doctoral student, identi-
fied the mutation, and with the
help of Prof. J. Goding from
Australia the group further suc-
ceeded in demonstrating that
the mutation causes loss of
function of the gene. This result
was surprising since previously
described inactivating mutations
in this gene were shown to
cause generalized arterial calcifi-
Mineral loss in bone, which
also leads to osteoporosis, affects
nearly 45 million post-
menopausal women (and a
smaller number of men) world-
wide. Bone mineral density has a
strong genetic component.
Many genetic variants have a
modest effect on mineral loss but
interact with environmental fac-
tors such as diet and exercise.
Although there has been exten-
sive progress in identifying the
genetic variants that regulate sus-
ceptibility to osteoporosis, most
of these apparently have yet to
be discovered. Bone contains
about 85 percent of total body
phosphate, but despite its broad
biological importance, the mech-
anism is only partly understood.
Only three genes have been
identified as crucial for the inter-
nal equilibrium (homeostasis) of
phosphate.
The identification of the new
gene contributes to a better
understanding of phosphate
homeostasis and possible inter-
vening in the pathological situa-
tions of reduced BMD and osteo-
porosis. Future research is needed
to verify the contribution of natu-
ral-occurring changes in this gene.
JERUSALEM TESTS NEW
OSTEOPOROSIS DRUG
Meanwhile, the osteoporosis
center at Hadassah University
Medical Center on Jerusalem’s
Mount Scopus is looking for
suitable candidates to partici-
pate in clinical trials of a new
experimental oral drug for
N
roid gland and causes increased
section of endogenous PTH,
which mimicks the function of
drugs such as Forteo. Experi-
mentation with animals and
Phase-1 tests (to show safety)
on healthy women showed that
the drug has a beneficial effect
like Forteo, which has the disad-
vantage of having to be injected
daily, is very expensive and can
be given for a maximum of two
years. The oral pill, given free to
participants, does not have such
disadvantages. In addition, most
women with osteoporosis are
not eligible to get Forteo from
their health funds.
Prof. Joseph Foldes, head of the
osteoporosis center, said he is
looking for postmenopausal
women aged 45 to 85 who have
been taking Fosalan (or its gener-
ic forms, Alendronate and Maxi-
bone) for at least three years. The
clinical trial is a double-blind con-
trolled study, with each partici-
pant having a four-out-of-six
chance of getting the new drug
and a one-out-of-six probability
of either continuing with Fosalan
or getting a harmless placebo. All
three options, says Foldes, are
valid in the clinical practice when
patients seek advice about
whether to continue long-term
bisphosphonate treatment for
osteoporosis. Thus, he says, there
is no real placebo.
Potential candidates, who
must commit themselves to
visit the hospital nine times for
tests, should call (02) 584-5100
or fax (02) 584-5050.
ile Perch used to be so prolific in Africa’s Lake
Victoria that it was called “Princess of the Nile”
in Israel to encourage consumers to buy it. But
the lake, discovered some 160 years ago, is
currently in a poor state of health, and
its fish population is depleted. The
clear waters have
turned murky and
stinky, and it is full
of algae. Some
native fish species
have even disap-
peared from the
lake, which borders
on Uganda, Tanzania
and Kenya.
Now researchers at the Hebrew Uni-
versity in Jerusalem and Makerere University LAST YEAR, the developers
in Kampala have established unique “boutique” began establishing ponds in
fish farms in small villages around the lake to help small villages, stocking them with
Uganda fight the declining fish population. carp from the fish farms and enabling
Locals used to catch carp and perciform fish near the the local population to eat them. The project has since devel-
shores of the lake, but half-a-century ago, Nile Perch oped, and now four large fish farms whose owners were
were introduced into Lake Victoria to increase local trained in Israel produce enough fingerlings to be raised in
fishing. The authorities did not realize that the species the ponds. Residents of each village – and especially their
is a predator that feeds on most of the other fish. children – eat the carp as their main source of protein. Lev-
While the Nile Perch became the primary export of avi-Sivan hopes that soon, every village around the shores of
the countries around the lake, over the past decade it Lake Victoria will have its own “boutique” fish farm, and that
has devoured many smaller fish around the shores of the project will be expanded to include other countries in
the lake and deprived local fishermen of their main Africa. “We succeeded in inducing spawning in the carp –
source of protein. Furthermore, fishing for the larger and these 14 villages are the success story.”
Nile Perch was unfeasible for local fishermen, as the The effort is part of a program organized by Mashav
fish reside in the middle of Lake Victoria, and larger (Foreign Ministry agency for international development
fishing boats are required to catch them. cooperation) and the HU’s division of external studies to
To combat this increasing problem, Prof. Berta Lev- study inland water aquaculture and help develop the
avi-Sivan of HU’s Robert Smith Faculty of Agriculture, existing project in Uganda.
Food and Environment found a way to spawn several The scientists are now facing another challenge – with the
species of African carp and cultivate them in Ugandan depletion of the lake’s smaller fish, the Nile Perch have noth-
fish farms. The project was initiated five years ago, and ing to eat and are themselves dying off. So they are launch-
has been financed by the US Agency for International ing a new project, financed by the World Bank, to find ways
Development, in collaboration with Dr. Justus Rutaisire of cultivating the Nile perch – thus helping boost Uganda’s
of Makerere University. fish exports, as well as the nutrition of the local population.

To order online: www.ucpress.edu/9780520259645
For a 20% discount use this source code: 10M9071
(please enter this code in the special instructions box.)
Birthing a Mother
The Surrogate Body and the Pregnant Self
Elly Teman
“Birthing a Mother is brilliant and beautifully written. It showcas-
es Teman’s great skills as an ethnographer and her sophisticated
analytic mind. She portrays all her subjects with empathy and
compassion, whether surrogates, intended parents, or profes-
sionals otherwise involved in the reproductive procedures she
documents.”—Charis Thompson, author of Making Parents
“Teman deftly portrays surrogacy as a joint project through which
one woman assists another, through sacrifice and instruction, to
become also a mother.”
—Heather Paxson, author of Making Modern Mothers
Birthing a Mother is the first ethnography to probe the intimate
experience of gestational surrogate motherhood. In this beautifully
written and insightful book, Elly Teman shows how surrogates and
intended mothers carefully negotiate their cooperative endeavor.
Drawing on anthropological fieldwork among Jewish Israeli women,
interspersed with cross-cultural perspectives of surrogacy in the
global context, Teman traces the processes by which surrogates
relinquish any maternal claim to the baby even as intended moth-
ers accomplish a complicated transition to motherhood. Teman’s
groundbreaking analysis reveals that as surrogates psychologically
and emotionally disengage from the fetus they carry, they develop a
profound and lasting bond with the intended mother.
Elly Teman is a Research Fellow at the Penn Center for the
Integration of Genetic Healthcare Technologies at the University
of Pennsylvania.
368 pages, 6 x 9”, 11 b/w photographs, 1 line illustration
$55.00 cloth 978-0-520-25963-8
$21.95 paper 978-0-520-25964-5