2016 Book CommodificationOfBodyPartsInTh

COMMODIFICATION OF
BODY PARTS IN THE

GLOBAL SOUTH
Transnational Inequalities and

Development Challenges
Firouzeh Nahavandi
Commodification of Body Parts in the
Global South
Firouzeh Nahavandi
Commodification of
Body Parts in the
Global South
Transnational Inequalities and Development
Challenges
Firouzeh Nahavandi
Université libre de Bruxelles
Bruxelles, Belgium
ISBN 978-1-137-50583-5 ISBN 978-1-137-50584-2 (eBook)

DOI 10.1057/978-1-137-50584-2
Library of Congress Control Number: 2016936511
© The Editor(s) (if applicable) and The Author(s) 2016

The author(s) has/have asserted their right(s) to be identified as the author(s) of this work
in accordance with the Copyright, Designs and Patents Act 1988.
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Printed on acid-free paper
This Palgrave Macmillan imprint is published by Springer Nature

The registered company is Macmillan Publishers Ltd. London
CONTENTS
1 Introduction 1
The Issue 3
Methodology of Research 7
References 10
2 Commodification of Human Body Parts 13

A Definition of the Commodification of Human Body parts 14
A Note on Terminology 16
Overview of the Social Sciences Literature 18
Classical Grounding 18
Gift or Commodity? 20
Freedom in Markets or Dehumanization? 21
Literature Related to the Working Cases 24
References 25
3 Transnational Hair Trade 31

Hair as a Commodity 31
The Demand 32
The Supply 35
References 38
v
vi CONTENTS
4 Transnational Surrogacy 41
The Womb as a Commodity 42
The Demand 44
The Commissioners 45
The Desire for a Child 46
The Supply 48
India, the Most Studied Destination 48
Other Destinations 53
References 54
5 Transnational Kidney Transplant 59

The Kidney as a Commodity 59
The Demand 62
The Supply 64
Poverty, the Cradle of Kidney Selling 64
Pakistan’s Sellers 65
The Philippines’ Sellers 66
Indian’s Sellers 68
Bangladesh’s Sellers 68
Other Countries’ Sellers 69
References 71
6 Transnational Attraction of Brains 75

The Issue 75
The Demand 76
Selective Migration Policies 78
International Graduate Students’ Policy 83
The Supply 85
A Trend Towards Highly Skilled Migration 86
The Role of Studying Abroad 87
References 89
7 The Commodification of the Human Body Parts

in a Development-Related Perspective 93
The Issue 93
Commodification of Human Body as Development-Related
Issue Linked to Poverty and Inequality 94
Poverty and Inequality 94
CONTENTS vii
Commodification of the Human Body Parts as a

Result of Poverty and Inequality 97
Commodification of the Human Body Parts as a Source
of Development Issues 105
The Inequality in Access to Healthcare 105
Consequences of the Attraction of Brains and the
Brain Drain 108
8 Ending Remarks 117

References 121
References 123
Index 129

LIST OF TABLES
Table 7.1 Comparative data on some ‘export’ and ‘import’ countries:

income, human development, poverty and inequality 98
Table 7.2 Comparative data on some ‘export’ and ‘import’ regions and
countries: emigration rate of tertiary educated (% of total
tertiary educated population) 103
Table 7.3 Global R&D funding as percentage of GDP 104
ix
CHAPTER 1
Introduction
Abstract This introduction presents the author’s perspective and outlines

the book’s objectives. In a world where nearly everything is traded, body
parts, similar to any other goods, have entered the global market in a pro-
cess now generally referred to as ‘commodification of human body parts’.
In that frame, Nahavandi aims to discuss a new type of appropriation of
resources from the poor—especially those who also live in poor countries—
to accomodate mostly the wealthier citizens and wealthier countries of this
world. Thus, the author argues that a development-related perspective
should be introduced in response to the commodification of the human
body. This perspective has not yet been considered by mainstream theories
of development and underdevelopment, nor has it been taken into consid-
eration in mainstream commodification of human body parts approaches.
Keywords Commodification • Kidney transplant • Hair sale • Surrogacy

• Attraction of brains • Globalization • Poverty • Inequality • Demand
• Supply
We live in a world where more and more goods are traded and consid-
ered to be tradable, a world of ‘universal commodification’ (Radin 1996),
which construes freedom as the ability to trade everything in free markets.
Consequently, in such an environment, everything has a price. Therefore,
similar to any other goods, body parts have entered the global market
© The Editor(s) (if applicable) and The Author(s) 2016 1

F. Nahavandi, Commodification of Body Parts in the Global South,
DOI 10.1057/978-1-137-50584-2_1
2 F. NAHAVANDI
both legally or illegally. They are coveted, advertised, negotiated, sold and
bought. Not all transactions have equal consequences; some body parts are
even extracted without the consent of the provider, due to existing demand
and the black market. Nevertheless, selling one’s body part is never an ano-
dyne act. It usually springs from necessity and despair. It does not equate
offering it, which in itself is already not anodyne. Consider the following:
you are not satisfied with your looks, especially with your hair. No worries!
You can enter a beauty salon, and buy natural hair extensions, which will
give you a brand new look. It will cost you a lot, but you will fulfill your
dream of beauty. Or say you want a child, but you do not want to or cannot
carry it; moreover, you do not want to adopt or maybe you do not fulfill the
conditions to be considered for becoming an adoptive parent. Neither is a
real problem. If you can afford it and are ready to enter the long procedure
that comes with it, you can turn your computer on and consult one of the
many websites offering reproductive services in your country. If they are not
legal or cost too much locally, someone in a faraway foreign country can
help you fulfill your dream of posterity. Finally, perhaps you are unfortunate
enough to experience kidney failure and need a transplant, but either don’t
fulfill the conditions to get an organ transplant or you do not want to linger
on long waiting lists. Again, if you can afford it, you can surely find a doctor
and a broker who will do their best to provide you with a kidney so you can
reach your dream of health and life. Consider now a completely different
case. You are a powerful and rich state. For one reason or another you need
specialists, as your own are not enough to respond to your need of hege-
mony and race for power and ranking. Again because you have resources,
you can afford to attract the best and the brightest by giving them multiple
opportunities and even a new citizenship. Knowledge and talent, like other
goods, have entered the global market and respond to the law of demand
and supply. Is this a caricature, or science fiction? Not really.
All these examples and cases illustrate a commodification process, which
characterizes today’s world, even though they represent different orders
of complexity, competition, and exploitation. Some transactions are legal
and some illegal, but they still go on. Some do not have consequences on
the health of the providers but may have negative social and psychological
consequences, as is the case for hair selling (Chap. 3). Some of these proce-
dures can lead to physical and psychological damages including death of the
providers, and require complex medical workups, careful matching, screen-
ing, and significant time, as is the case for surrogacy or kidney transplant
(Chaps. 4 and 5). And finally, migration of brains might have advantages
for the individuals and their families, or even the exporter state however,
INTRODUCTION 3
it also may lead to serious long-term problems for some provider states
(symbolic body), beyond identity and belonging problems for the migrant
who is scarcely eager to leave everything behind if he is not obliged to do
so, and who is after all selling his know-how when other potential migrants
will never get the chance to be welcomed abroad. For years, brain drain has
been a problem for developing states. The new ‘attraction of brain’ poli-
cies of developed states adds more complexity to this already non-resolved
issue, as today’s incentives included in migration policies can be interpreted
as a way of buying know-how (brain as a body part) (Chap. 6).
As a citizen-consumer, you do not have to know where everything
comes from; you just have to be able to write the check. Indeed, the
‘suppliers’ can remain invisible. However, if you dig a little, you will find
that an Indian or a Vietnamese woman has given away her hair, or has
been robbed of one of her most treasured possessions (Chap. 3). Another
woman, somewhere else, is living for a while in a reproductive center, a
‘baby factory’ where she has rented out her womb to gestate your child,
and is maybe experiencing emotional damage by not taking home the
baby she has carried and delivered (Chap. 4). And finally, someone you
have never met, living in a faraway slum is selling his/her kidney to built
the house destroyed by a typhoon or to send his/her kids to school (Chap.
5) and is maybe suffering from serious health problems due to the extrac-
tion. As a state, you also do not have to really bother about the conse-
quences of the attraction of brain and the looting of the know-how as, for
you, the ‘raison d’Etat’ and economic primacy prevail all else (Chap. 6).
THE ISSUE
What are the commonalities between these cases and examples? The pat-
tern is clear: providers are mainly from developing countries and ben-
eficiaries are generally wealthy individuals from developed countries or
wealthy countries themselves. Though, in today’s globalized world, the
issue is getting more complex. Wealthy consumers from everywhere have
integrated the global market. Furthermore, some less wealthy women may
go into heavy debt to pay for hair extensions. Some less well-off women/
men can also borrow to obtain a baby, while some individuals and families
may sell all that they have, borrow from friends and kin, and even inden-
ture themselves to purchase a kidney for themselves or someone dear to
them. Hence, together with universal commodification, which “under-
mines personal identity by conceiving of personal attributes, relationships
and philosophical and moral commitments as monetizable and alienable
4 F. NAHAVANDI
from self” (Radin 1987), a new process of appropriation of resources is

progressively becoming ‘normalized’ and is being established as a new,
albeit unequal, exchange between the have and have not, and the Global
North and the Global South. Although, to some extent, this process also
exists within high-income countries or within low-income countries, this
book focuses only on the Global North-South relations where the phe-
nomenon is substantially broader and the consequences more severe.
This book is about different levels and instances of what is now gener-
ally referred to as ‘commodification of human body parts’ (Chap. 2) and
how a new type of appropriation of the resources of low-income countries
by high-income countries (hereinafter, the Global South and the Global
North) has grown. Features of today’s globalization and the neoliberal
economic order, as well as the poverty and inequality that still characterize
the international order have permitted and facilitated this appropriation
(Chaps. 3–6).1 Just as in previous centuries, when exploitation through
slavery or colonization were barely discussed and were considered ‘nor-
mal’, appropriation of the body parts of the poor and marginalized from
the Global South, and hence their objectification, appears to have become
similarly ‘normalized’. Today, individuals, as did the states in previous cen-
turies, buy and outsource scarce resources (body parts) where the supply
is abundant: from the poor in the Global South.
Debates surrounding the commodification of the human body are man-
ifold and increasing. Although such debates are often constructive, most
of them have overlooked the contextual dimensions of the process in the
Global South, which is characterized by pockets of poverty and inequal-
ity, and the transnational inequalities which sustain it. By focusing on the
demand and supply of the body parts, this book illustrates the inequality
of conditions between the suppliers and buyers. Poverty and inequality
perpetuate the commodification process and transform poor people, or
countries, into suppliers of body parts for the wealthiest all over the world
(Chap. 7). Therefore, not taking into consideration the context may hin-
der the implementation of adequate measures addressing the issue. Thus,
this book also argues for a development-related perspective to be intro-
duced into responses to the commodification of the human body. As long
as people are ready and sometimes eager to sell their body parts because of
their situation, the issue of commodification of human body parts cannot
be completely tackled. This means that more attention should be given to
the suppliers and their situation. Framing the transactions or regulating
them will never suffice to stop people from readily endangering them-
INTRODUCTION 5
selves in order to address their basic needs and aspirations or those of their
family, and therefore be willing to subject themselves to exploitation. The
commodification issue is a global one, which requires drawing attention to
the ongoing poverty and inequality of the world.
This book integrates thirty years of experience from my work in devel-
opment research and teachings along with my fieldwork, mainly in Asia
and Africa that have provided me with a look at the evolution of the
development process. I have observed and studied the results of succes-
sive development plans and economic models and assessed the damages
of poverty and the results of the neoliberal stance and economic glo-
balization, which started in the 1970s. I have considered, with interest,
all the new steps and roadmaps in the framing of development policies,
especially those intended to overcome poverty, such as the Millennium
Development Goals, nowadays replaced with a new commitment that
aims to eliminate extreme poverty by 2030. One of the main characteris-
tics of the post-2015 agenda is to focus on what matters most to the poor.
Nevertheless, these plans do not really include an explicit goal of reducing
income inequalities. Poverty is a phenomenon as old as human history.
Although its significance may have changed over time (Rahnema 2003)
it is still a global problem. Hunger is one of its dimensions. According to
the United Nations Food and Agriculture Organization, about 805 mil-
lion people of the 7.3 billion people in the world, or around one in nine,
were suffering from chronic undernourishment in 2012-14, regularly not
getting enough food to conduct an active life. The majority, 791 million,
lived in developing countries, representing 13.5 percent, or one in eight,
the population of those countries (FAO, IFAD and WFP 2014).
In turn, inequality has also existed since the beginning of human his-
tory. The Greek philosopher Plutarch noted in his time: “Disequilibrium
between rich and poor is the most ancient and fatal sickness of Republics”
(Galbraith 2011, p. 22). Inequality continues to be a global problem and
a barrier to poverty reduction. The last Oxfam Reports state that almost
half of the world’s wealth is owned by just 1 percent of the population,
and seven out of ten people live in countries where economic inequality
has increased in the last 30 years. Extreme economic inequality is damag-
ing and worrisome for many reasons: it is morally questionable; it can have
a negative impact on economic growth and poverty reduction; and it can
multiply social problems. Furthermore, it compounds other inequalities,
such as those between women and men (Fuentes-Nieva and Galasso 2014;
Hardoon 2015). Poverty and uneven distribution of wealth, resources and
6 F. NAHAVANDI
power are closely related, and encourage another age-old problem: the
exploitation of human beings. In this book, my objective, by addressing
commodification of the human body, is to focus on an additional dimension
of inequality in transnational relations, which is derived from the growth
of new phenomena induced by remaining poverty and inequality along
with the progress of science, increased connectedness of the world, and
market-oriented economic model. Amidst the neoliberal readjustments of
the new global economy, there has been a rapid growth of procedures that
include developing countries and some of their citizens in new transna-
tional transactions. New recipes marred with inequities make participate,
by selling their body parts, the poorest and marginalized individuals of the
world in todays’ market-oriented society; and global race for talent leads
well-educated citizens of developing world to sell their know-how (brain)
and respond to the best offer. As already mentioned the underlying pat-
tern is the same: resources from the Global South’s bodies are extracted
mostly in benefit of the Global North and their citizens. Thus, with this
book I intend to draw attention on a dimension which has not been con-
sidered per se by the commodification of body parts approaches, and not
tackled by mainstream development and underdevelopment theories, thus
adding another example to the unequal exchange’s discussion.
Even though some phenomena addressed in the following chap-
ters have existed in one form or another for a long time, including hair
trade, recourse to wet nursing (Wolifer 2000) prior to surrogacy, or again
attracting talent by way of patronage, their range and scope have widened
considerably due to some key features of today’s globalization. For exam-
ple, neoliberal policies have opened the health care system of developing
countries to medical and transplant ‘tourism’. The market-driven econ-
omy has allowed transactions as part of individual freedom. The advances
in science and technology have allowed treatment of body parts in a way
never thought of before. The Internet has made a truly global market
place possible, created new markets, and established broad possibilities
for the consumer. The revolution in transportation has allowed quick
links to numerous destinations. Furthermore, globalization has opened a
worldwide race for primacy, with countries attracting talents to position
themselves as centers of excellence, and for the Global North to sustain
hegemony. Globalization can help build a better world; it has already sup-
ported the creation of opportunities for some people, groups and coun-
tries. However, it has also conveyed new vulnerabilities (UNDP 2014)
and the current economic order is also increasing inequalities and rein-
INTRODUCTION 7
forcing disparities in economic structures, and social conditions between

the wealthiest countries and most of the rest of the world (Sassen and
Appiah 1998; Streeten 2001) and between people. The scope of ‘choices’
offered to some increases, while it diminishes for others—particularly,
access to health care systems, education systems, and job creation relevant
to this study. Social injustices are part of commodification.
By focusing on the commodification of the Global South’s body
parts, Commodification of Body Parts in the Global South: Transnational
Inequalities and Development Challenges contends that silently but steadily,
new types of resources from poor countries are benefiting mostly the
wealthier citizens and wealthier countries of this world. In this framework,
commodification of the human body appears as a new type of ‘unequal
exchange’ (Emmanuel 1972), a form of ‘neo-colonialism’, not to say
‘neo-cannibalism’ (Scheper-Hughes 1998; Rainhorn and El Boudamoussi
2015). As in the previous centuries, resources from colonized countries
were extracted for the benefit of colonizing powers; the current process is
the continuation of the former with ‘new clothes’ to refer to Andre Gunder
Frank’s (1996) phrase for modernization theories. ‘Unequal exchange’
refers here to the inequalities enacted through transnational trade and
state policies wherein economically dominant actors appropriate new type
of resources. Individuals and countries advantageously situated within the
global economy secure favorable terms of transactions fuelling access to
body parts. Through this lens, commodification of the human body also
illustrates the intersection between supply and access with other social and
political categories—race, ethnicity, class, gender, kinship, national bor-
ders, citizenship, migration and religion—that are at play.
METHODOLOGY OF RESEARCH
Literature on the commodification of the human body and the complex
phenomenon characterizing it are abundant. This book relies on existing
multi-site and transnational case studies and fieldwork on the phenom-
enon, and on a literature review of canonical and contemporary research
about the sociology of hair and hair trade, surrogacy, kidney transplant,
migration and brain drain. In addition to academically rich and well-
documented publications, international reports, news reports and web-
sites related to the subject have been sourced. Drawing on those accounts,
and in light of my own experience, I have gathered and combined four
types and levels of commodification of human body, namely hair trade;
8 F. NAHAVANDI
surrogacy and kidney transplants, which are comparatively the most often
discussed; and attraction of brains, which is also progressively considered
by specialists in frame of a commodification process. These four working
cases are usually studied independently of one another in the mainstream
literature. Considering them altogether in this book may seem discon-
certing at first sight, however it aims to initiate a reflection and discus-
sion about how these events are part of new inequalities that define the
relations between developed and developing countries (the Global North
and the Global South) leading to the extension of the appropriation of
resources specific to colonialism. Transnational hair trade, surrogacy, kid-
ney transplant, and the attraction of brains are considered here as being
new epitomes of development-related problems. Rooted in remaining
and/or growing poverty in the Global South, they constrain people to
sell their body parts: hair, womb and kidney. Growing offers in migration
policies of the Global North incapacitate many countries from resisting—
by way of their institutions and labor market—the ever growing demand
from wealthier countries for ‘brains’, coercing the ‘best and the brightest’
to respond.
The review of all sources includes a reading of many aspects linked to
each working case. Identification of all sources has been based on keyword
searches, followed by thematic cataloguing through content analysis. Each
case straddles many approaches, notably legal, philosophical and ethical,
anthropological, economical and feminist. The presentation of the issue
of commodification in each chapter is based on theoretical, historical and
general framing, as does the presentation of demand. The presentation
of supply has mostly mobilized publications, which focus on the Global
South, and case studies and ethnographic research are favored. I am well
aware that these phenomena do exist within the Global North, however,
as already mentioned, their scope and range are much less important and
their consequences much less severe than when they take place in the
Global South. For example, “the surrogacy industry in India is tipped to
be 2.3 billion dollars annually. However, there is no law to regulate them”
(Jha 2015). Moreover, the aim of the book is to draw attention to the
Global South’s dimension of the phenomenon, as other issues linked to
commodification of human parts as, among others, the ethical dimension,
the legal dimension, and the medical implications have already been richly
discussed and furthermore are increasing, among others, in England,
France or Belgium, for example in frame of the recent debates around sur-
rogacy (Laurent 2015; Macfarlane 2015; Van De Woestyne 2015).
INTRODUCTION 9
This book is divided in three parts. First, I present a definition of the

commodification of the human body and a brief survey of the literature.
Second, I review the four working cases previously mentioned. Each repre-
sents one type of commodification and a different range of commodifica-
tion, going from a simple form of commodification (hair) to more complex
levels (surrogacy and transplant) and then to more symbolic (brain). Some
readers may be surprised by the integration of the four cases into the same
category. Certainly, hair trade seems a less severe case of commodification
and attraction of brains a more symbolic, less gruesome example, since
brains are not taken out of the individual body, but out of the symbolic body
(society). Hiring wombs does not necessarily entail injuries as do the sale of
kidney by way of which the seller is very often physically worse off after the
sale. Nevertheless, every case discussed clearly illustrates a commodification
process and an appropriation of resources from the Global South, by way
of which human beings and their parts are objectified and integrated in the
global market. The classification and the market rhetoric adopted in this
book are intended to draw attention on the transnational market, which
today characterizes the phenomenon, and to nourish the discussion. The
chapters on working cases are divided in three: a brief presentation of the
phenomenon, a survey of demand, and finally an overview of the supply.
Likewise, it becomes possible to highlight the intersection of factors that
are inherent to the process of commodification such as, among others, gen-
der, class, race, kinship, nationality or religion. Confronting demand and
supply emphasizes the inequity that underlies it and the complexity of the
issue. The final chapter discusses the facts presented in the previous chapters
through a development-related lens, highlighting the new appropriation of
resources inherent to a market driven economy and society.
NOTE
1. A draft of this book has been presented at the International symposium (6-7
February 2014) Globalization and Commodification of the Human Body: A
Cannibal Market? and published as “From Colonization to Neocolonization:
New Forms of Exploitation” in New Cannibal Markets (Rainhorn and El
Boudamoussi 2015). I have appreciated Professor Jean-Daniel Rainhorn’s
support and am grateful to him for having encouraged me to explore a new
field in my career. I also am grateful to my sister, Professor Afsaneh
Nahavandi, for her reading and her support to this work. I would like to
acknowledge the helpful suggestions and comments provided by the anony-
10 F. NAHAVANDI
mous peer reviewers and their very detailed reading, comments and sugges-
tions that finally led to this publication. I have also appreciated Ambra
Donatella’s patience and support in the process of preparing this
manuscript.
REFERENCES
Emmanuel, A. (1972). Unequal exchange: A study of the imperialism of trade.
New York and London: Monthly Review Press. First published in French 1969.
FAO, IFAD, and WFP. (2014). The state of food insecurity in the world. Strengthening
the enabling environment for food security and nutrition. Rome: FAO. Retrieved
June 27, 2015, from http://www.fao.org/3/a-i4030e.pdf.
Frank, A. G. (1966). The development of underdevelopment. New York: Monthly
Review Press.
Fuentes-Nieva, R., & Galasso, N. (2014). Working for the few: Political capture
and economic inequality. Oxfam Briefing paper, 178. Retrieved February 1,
2014, from http://www.oxfam.org/sites/www.oxfam.org/files/bp-working-
for-few-political-capture-economic-inequality-200114-en.pdf
Galbraith, K. (2011). The art of ignoring the poor. Paris: Les lignes qui libèrent.
Hardoon, D. (2015). Wealth: Having it all and wanting more. Oxfam Issue
Briefing. Retrieved March 20, 2015, from https://www.oxfam.org/sites/
www.oxfam.org/files/file_attachments/ib-wealth-having-all-wanting-more-
190115-en.pdf
Jha, D. N. (2015, July 17). No law to regulate booming industry. Times of India.
Retrieved July 20, 2015, from http://timesofindia.indiatimes.com/city/
delhi/No-law-to-regulate-booming-industry/articleshow/47966298.cms
Laurent, S. (2015, May 20). Comment la France évolue sur la gestation pour
autrui. Le Monde.
Macfarlane, J. (2015). I’ll never give up Burger King Baby to his gay fathers. Mail
Online. July 11. Retrieved July 19, 2015, from http://www.dailymail.co.uk/
news/article-3157706/I-ll-never-Burger-King-baby-gay-fathers-Surrogate-
mother-reveals- heartbreaking-story-lifts-lid-Britain-s-chaotic-cruel-baby-
trade.html
Radin, M. J. (1987). Market-inalienability. Harvard Law Review, 100,
1849–1937.
Radin, M. J. (1996). Contested commodities: The trouble with trade in sex, children,
body parts, and other things. Cambridge: Harvard University Press.
Rahnema, M. (2003). Quand la misère chasse la pauvreté. Paris: Fayard.
Rainhorn, J.-D., & El Boudamoussi, S. (2015). New cannibal markets:
Globalization and commodification of the human body. Paris: Maison des
Sciences de l’Homme.
INTRODUCTION 11
Sassen, S., & Appiah, K. A. (Eds.). (1998). Globalization and its discontents: Essays
on the new mobility of people and money. New York: New Press.
Scheper-Hughes, N. (1998). The new cannibalism: A report on the international
traffic in human organs. New Internationalist, 300, 14–17.
Streeten, P. (2001). Globalisation: Threat or opportunity. Solbjerg Plads:
Copenhagen Business School Press.
United Nations Development Programme. (2014). Human development report
2014, sustaining human progress: Reducing vulnerabilities and building resil-
ience. New York: UNDP. Retrieved July 20, 2015, from http://hdr.undp.org/
en/content/human-development-report-2014
Van De Woestyne, F. (2015, May 3). Bébés à vendre. La Libre Belgique.
Wolifer, L. (2002). The political geographies of pregnancy. Urbana and Chicago
University of Illinois Press.
CHAPTER 2
Commodification of Human Body Parts
Abstract Chapter 2 presents a working definition and evidence of using

the expression ‘commodification of human body parts’, followed by an
overview of the social sciences literature and a state of discussion on the
phenomenon. The commodification of the human body parts, discussed
within many disciplines, is a very contentious, if not an explosive issue,
as all authors do not agree on what counts as commodification or what
constitutes a body part. Nahavandi favors the definition used by medical
anthropologists, who insist upon objectification in some form, transform-
ing persons and their bodies into objects of economic desire. However,
this chapter draws from contrasting understanding of commodification by
the authors and particularly includes a discussion on freedom in markets
versus dehumanization.
Keywords Commodification • Objectification • Unequal exchange •

Gift • Dehumanization • Freedom in markets • Hair sale • Surrogacy •
Kidney traffic • Attraction of brains
This chapter presents a working definition and evidence of using the

now idiomatic expression ‘commodification of human body parts’, fol-
lowed by an overview of the literature and a state of discussion on the
phenomenon. Recently, the expression ‘body shopping’ has commonly
been employed (Xiang Biao 2007; Dickenson 2008). Hereinafter, ‘global

DOI 10.1057/978-1-137-50584-2_2
14 F. NAHAVANDI
market’ is used to refer to the transnational characteristics of the process

and transfers involving a broad range of actors, buyers, sellers, doctors,
brokers, and many other intermediaries, and new procedures. “Global
capitalism and advanced biotechnology have together released new med-
ically-incited ‘tastes’ for human bodies, living and dead, for the skin and
bones, flesh and blood, tissue, marrow, and genetic material of ‘the other’”
(Scheper-Hughes 2000a). In the same way, the global race for talent has
initiated a new demand for specialists and is giving way to increased incen-
tives to attract ‘brains’ to countries that can afford it, and are particularly
eager to preserve or improve their rankings.
A DEFINITION OF THE COMMODIFICATION OF HUMAN

BODY PARTS
In the past, human body parts have been utilized in many ways and have
also been targets for commodification. From the absorption of human
flesh (cannibalism) to body sacrifice in religious ceremonies, or the phar-
macological and medical treatment purposed use of the body, examples
abound. All civilizations have resorted, in one way or another, to the use
of human body parts (Desclaux 2006), therefore, utilization is not a new
phenomenon and neither is commodification per se, exemplified in well-
known historical facts such as slavery or colonization. Nevertheless, the
commodification of the human body parts has become a very conten-
tious, if not an explosive issue as of today. All authors do not agree on
what counts as commodification or even what constitutes a body or its
parts. Among others, Nancy Scheper-Hughes (2001a), one of the found-
ers of the Berkeley Organs Watch project, has extensively studied organ
commodification and traffic in human body. She acknowledges that com-
modification is a problematic concept and highlights that there is con-
troversy on the practices to be included while some of the latter are not
new. Law professors, Radin and Sunder (2005, p. 8) draw “the changing
subject(s) and object(s) of commodification. [They trace] how the aca-
demic discourse evolved, both in its treatment of commodification as an
academic topic (subject) of study and in its views of the purpose (object)
of commodification, as well as how the discourse evolved in its views of the
subject in a relationship of commodification (the owner) and the object
in a relationship of commodification (the thing owned)”. In this book,
the definition used by medical anthropologists, who among scholars have
particularly addressed the issue, is favored. However, I call for an inter-
disciplinary approach, including a development-related perspective, which
COMMODIFICATION OF HUMAN BODY PARTS 15
could lead to an informed knowledge of the phenomenon and to the best

possible measures framing it at present.
Scheper-Hughes (2001a, p. 2) offers a broad understanding of the con-
cept “encompassing all capitalized economic relations between humans in
which human bodies are the token of economic exchanges that are often
masked as something else -love, altruism, pleasure, kindness-”. In turn,
anthropologist Lesley Sharp (2000, p. 293) argues: “Commodification
insists upon objectification in some form, transforming persons and their
bodies from a human into objects of economic desire. Thus, the presence of
objectification in a host of forms is significant because it flags the possibility
that commodification has occurred”. Many philosophers agree. Marway,
Johnson and Widdows (2014), scholars in the department of philosophy
at the University of Birmingham, go further and offer two interconnected
elements central to any concept of commodification: on one hand that it
turns ‘persons’ into ‘things’; and on the other that it changes ‘relationships’
into ‘contracts’. “Use and exchange value (separately and/or together) are
regarded as indicative of moves towards commodification in some form. To
commodify is to take something of intrinsic worth (such as ‘persons’) and
to objectify it by giving it a use value (so it has-or is subjected to processes
that liken into- the status of ‘things’) and to commercialize it by giving it
an exchange value, or by implying that it could be sold (further degrading it
to the level of tradable ‘things’)”. Thus, individuals and their parts become
thought of not as ‘persons’ but as ‘things’ (Wilkinson 2004). According to
the anthropologist Appadurai (1988a, b, p. 15), “commoditization lies at
the complex intersection of temporal, cultural, and social factors. To the
degree that some things in a society are frequently to be found in the com-
modity phase, to fit the requirement of commodity candidacy, and to appear
in a commodity context, they are its quintessential commodities. To the
degree that many or most things in a society sometimes meet these crite-
ria, society may be said to be highly commoditized. In modern capitalist
societies, it can safely be said that more things are likely to experience a
commodity phase in their own careers, more contexts to become legiti-
mate commodity contexts, and the standards of commodity candidacy to
embrace a large part of the world of things than in non-capitalist societies”.
To summarize, the term commodification, broadly construed, includes not
only buying and selling something, but also regarding it in terms of market
rhetoric, and thinking about interactions as if they were sale transactions.
This book is not about all forms of commodification, and certainly
selling/buying hair does not equate the consequences of selling/buying
kidneys or wombs and moreover, knowledge (brain). However, from this
16 F. NAHAVANDI
book’s perspectives and the argument presented, all participate in unequal

transactions by way of which the resources extracted from the weakest ben-
efit the strongest. Furthermore, they are indications of some broader trends
that are the focus of this book: new appropriation of resources from the
poor, and between the Global South and the Global North or their citizens.
A NOTE ON TERMINOLOGY
The process of commodification and the reality of the global market have
given way to the use of ad hoc vocabulary, which illustrates the contrast-
ing understanding of commodification by the authors. Although some
concepts and terms seem interchangeable, and may indeed often be uti-
lized indifferently in the literature, they nevertheless are linked to different
paradigms and convey different ideas, values and standpoints. The grow-
ing debates about appropriate terminology range from the use of the term
‘commodification’ itself to the labeling of each of the processes illustrated
hereafter in the four working cases. As it is impossible to address all, I will
consider some of them as a way to highlight the engendered controversies.
Among others, discussion bears upon the necessity to use adequate terms
as some may, as highlighted by Dona Dickenson (2012), add a spuri-
ous legitimacy to practices that we ought to be interrogating as ethically
questionable. For example, being a donor or a supplier does not convey
the same idea. Being a donor usually refers to a gift relation. Dickenson
discusses terms such as ‘egg donor’, which as she writes transform a trans-
action into an altruist act. She suggests ‘egg supplier’ neutral enough to
encompass altruist donation too. The same goes with the term ‘surrogate
motherhood’. We will see below that some surrogates increasingly pre-
fer ‘gestational carrier’, which minimizes the emotional link between the
career and the baby. I shall use the latter hereafter as it best conveys the
idea of a market. For the ‘commissioners’ (term which I shall use hereaf-
ter) among others ‘fertility contractor’ (Greil 1991), or ‘fertility traveller’
(Hudson et al. 2011) have been employed. Clearly being a contractor
or a traveller does not convey the same idea. Surrogacy has also given
way to various terminologies and especially the one related to travelling.
‘Reproductive tourism’, playing on the tourism angle does not convey the
trials endured by infertile couples nor does it convey the situation of the
gestational carrier, especially in some developing countries. ‘Cross-border
reproductive care’ would perhaps be more appropriate (Dickenson 2012,
p. 28; Whittaker 2011). The term is “consistent with the standardized
definition proposed by the European Society of Human Reproduction

and Embryology” (Whittaker 2011, p. 108). However, others prefer ‘fer-
tility tourism’ as the term emphasizes “that clinics in destination countries
are motivated by profit and furthermore are part of the multibillion dollar
medical tourism industry” (Pfeffer 2011, p. 628). ‘Procreative tourism’
(Knoppers and Lebris 1991), ‘reproductive exile’ (Inhorn and Patrizio
2009; Matorras 2005) and ‘offshore surrogacy’ (Cuthbert and Fronek
2014) have also been used and explained. Hereafter, I favor transnational
surrogacy, as it highlights links with globalization and better translates
the purpose of this book, which focuses on the relations between the
Global South and the Global North. Sharp (2006) conveys the same idea
of cautious use of terms about transplantation and the way the weaken-
ing of public trust to medical procedures have led to an increasing use of
euphemism that obscure, among others, the commodification of cadaveric
donors and their parts, as the shrouding of body commodification in the
language of a gift economy. Michele Goodwin (2006), in turn highlights
that in the new lexicon of organ transplantation, black market shopping is
now known as ‘transplant tourism’ or ‘organ tourism’. Although the term
tourism is contentious, as it does not convey the desperate situations of
the traveller or that of the seller, ‘transplant tourism’ is used in interna-
tional heath policy discussion to refer to overseas transplantation when a
patient obtains an organ through the organ trade or other means that con-
travene the regulatory frameworks of their countries of origin (Shimazono
2007). According to Scheper-Hughes and Roberts (2011, p. 19), trans-
plant tourism is also “a misappropriation of the term tourism -even though
the agents and the victims both use the term to conceal the illegality of
the arrangements. Transplant traffic is a term synonymous with interna-
tional drug traffic and global sex trafficking, and they share the following:
organized crime syndicates, traffickers posing as brokers or passeurs and
vulnerable people used as ‘mules’”. Furthermore, today’s market rhetoric
regards organ sale as a ‘service’, which facilitates it and transforms a com-
plex relationship into a delimitated transactional affair.
The issue of the ‘attraction of brains’ expression, which I shall use here-
inafter, has also been conceptualized in many ways. The conventional aca-
demic and institutional labeling since the 1960s has been ‘brain drain’.
However, due to the complexification of the process and the increasing
demand of highly skilled labor in the Global North, other concepts are
being mobilized: ‘global race for talents’, ‘picking the winners’ (Shachar
2006, 2009, 2011; Shachar and Hirschl 2013), ‘commodification of
18 F. NAHAVANDI
labor’ (Rosewarne 2010), ‘body shopping’ (Xiang Biao 2007) and ‘the
great brain race’ (Wildavsky 2010). Finally, for highly skilled migrants,
among authors, terminology is also diversified. They are designated as ‘the
best and the brightest’ (Kapur and McHale 2005), ‘the wanted and wel-
come’ (Triadafilopoulos and Ohliger 2013), ‘the super talents’ (Shachar
2006; Shachar and Hirschl 2013), ‘the extraordinary ability’ category
(US Citizenship and Immigration Services), ‘the distinguished talents’
(Australia Migration Program) and ‘the exceptional talents’ (UK Border
Agency).
To summarize, labeling highlights the ongoing controversies and the
lack of agreement on what is commodification and what is a body part.
Therefore, one should pay attention to the concepts used by the authors,
particularly as the labels refer to the level to which the phenomenon has
been normalized’.
OVERVIEW OF THE SOCIAL SCIENCES LITERATURE

This book does not spring from a vacuum; commodification of the human
body has generated a plethora of literature. Besides the publications out-
lined below, a careful reader will find regular scientific inquiry about each
of the four working cases addressed in this book in specialized scientific
reviews (law, medical, ethics, feminist, anthropology, sociology, economy
and so on) as well as in international reports and institutional publica-
tions. Each has generated specific writings and theoretical stances. In the
framework of social sciences literature, for example, debates over com-
modification have occurred primarily within two disciplinary frameworks:
economics and cultural studies (Ertman and Williams 2005); surrogacy
is more frequently analyzed in a feminist approach; hair sale in sociology,
post colonial approach and history; organ transplants are more discussed
on philosophical and ethical approaches of personhood and property; and
attraction of brains has been part of migration debates. Hence, the publi-
cations reviewed below are illustrative rather than exhaustive.
Classical Grounding
Overall, the literature applicable to commodification is grounded in
some classical works, to which many specialists refer. On property rights,
seventeenth-century philosopher John Locke (1980) is often cited. He
argued that property rights flowed from mixing labor with raw materials
of the production process. He is at the source of the belief that we own our
bodies, and that we have a rightful claim to own the results of mixing the
labor of our bodies with raw materials. However he distinguished persons
and bodies and labor of our bodies and the bodies themselves. The issue of
body property, the importance of autonomy as well as the contemporary
understanding of dignity are often linked to eighteen-century philosopher
Emmanuel Kant (1981). For the latter, something may be either a person
or a thing; everything has either a price or a dignity, but not both. Since
we as persons inhabit our bodies, they are not things like other consumer
goods. Kant denied that we could autonomously choose to treat our bod-
ies merely as a means to an end, such as raising money. Karl Marx (1875),
even though he did not consider commodification of human body parts,
wrote about the factory goods of nineteenth-century industry, and was
probably the first author to give a working definition of commodifica-
tion. “A commodity is, in first place, an object outside us, a thing that by
its properties satisfies human wants of some sorts or another. The nature
of such wants, whether, for instance, they spring from the stomach or
from fancy, makes no difference”. He distinguished between attributing
‘use value’ to something (objectifying) and ‘exchange value’, making it
an object of exchange (commodifying). The first refers to the physical
properties of an external object, whereas the second refers to the worth of
that object if it were traded. Marx’s interpretation of market transforming
relations between men in relations to property owners is still frequently
commented. According to him, gifts and commodities are not objects,
but transactions and social relations. Another often-referenced author is
the French socio-anthropologist Marcel Mauss (1967), who argued that
gifts are never free. They are total social facts, a reality, which gives way to
the idea that commodities are not static objects, and as Appadurai (1988a,
b, p. 4; Kopitoff 1988) puts it, although “the powerful contemporary
tendency is to regard the world of things as inert and mute” things have a
social life. “Commodities are things with a particular type of social poten-
tial, that they are distinguishable from products, ‘objects’, ‘goods’, ‘arti-
facts’, and other sorts of things” (Appadurai 1988a, b, p. 6).
More contemporary, often-quoted authors are the philosopher
Michel Foucault and the sociologist Richard Titmuss. Foucault’s writ-
ings (1994, 1995) on clinical practice and its link to sociopolitical power
opened a new area of discussion. “The research that I am undertaking
here involves a project that is deliberately both historical and critical, in
that it is concerned -outside all prescriptive intent- with determining
20 F. NAHAVANDI
the conditions of possibility of medical experience in modern times”

(Foucault 1994, Preface). Foucault coined the term ‘medical gaze’ to
denote the dehumanizing medical separation of the patient’s body from
the patient’s person. He depicted the act of gazing by a doctor in a man-
ner that renders the body as an object. The above cited publication was
moreover a critical history of public health in the world, the emergence
of governmentality, regulated social spaces and eventually self-regulated
bodies. Titmuss (1997) and his now classical but outmoded book The
Gift Relationship, a comparative study of the systems of blood dona-
tion and distribution after the Second World War, where he argued that
altruistic systems of blood collection were both morally and practically
superior to paid ones, is one of the more recent authors abundantly
referred to, and discussed, especially regarding organ donation and
selling. Catherine Waldby and Robert Mitchell (2006) have dedicated
part of their comprehensive book on tissue transfer to a presentation
and discussion of Titmuss’s approach, considering it as inescapable. All
together, blood donation and human tissues have been subject to many
publications from the historical point of view to the analytical and criti-
cal stance (Fox and Swazey 1992; Hurley 1995; Joralemon 1995, 2000).
Gift or Commodity?
The dichotomy of gift and commodity that has organized bioethical and
sociological evaluations on issues linked to the capacity to fragment the
body, and the techno-social systems that manage and distribute the frag-
ments are in length examined by Waldby and Mitchell. According to them,
analyzing tissue economies in only gift-commodity terms is oversimplifying
the terrain of the contemporary tissues economy. Parry (2008) also desta-
bilizes the gift-commodity dichotomy arguing its inability to adequately
accommodate the multiply constituted and complex range of transactions
that attend the contemporary circulation of human body parts and tis-
sues. The increase in demand for biomaterials has been well documented
(Fox and Swazey 1992; Scheper-Hughes 2000b; Sharp 2000; Waldby and
Mitchell 2006).
Within the literature, some publications cannot be overlooked.
Among them is the work of Scheper-Hughes (2000a, b, 2001a, b,
2005). The examination of structural and political violence, what she
calls “small wars and invisible genocides”, is invaluable. She dedicates
her research, writings and teaching focus on violence, suffering and pre-
mature death as these are experienced on the margins and peripheries of

the late modern world (Watters 2014). Also valuable is Sharp’s article
(2000) ‘The Commodification of the Body and its Parts’, an interdisci-
plinary approach of body and commodification of body parts where the
author insists that a universalistic thinking on the meaning of body ham-
pers analysis. Her article highlights established theories on the exploit-
ative use of the body and its parts. Another publication that cannot be
overlooked is (1988) The Social Life of Things, Commodities in Cultural
Perspective, edited by Appadurai, a volume that bridges the disciplines
of social history, cultural anthropology and economics, and introduces
a rich discussion on the meaning that people attribute to things, which
necessarily derives from human transactions and motivations, particu-
larly from how those things are used and circulate in different contexts
and a variety of societies.
Freedom in Markets or Dehumanization?

The literature on commodification of humans includes many publica-
tions where some see freedom in markets, others sense despairing capit-
ulation or inexorable dehumanization and furthermore some adopt an
in-between position. The focus is mainly on organ sales and traffic in
organs. Arguments are sometimes influenced by the authors’ field, for
example, economics versus ethics, or anthropology versus medicine. Here
I shall consider only the social science approach. For the Chicago school
of economics scholars, such as Gary Becker and Elias (2007), everything
is already commoditized and has a price, and individual preferences are
considered as exogenous to the market, which in turn is presented as
merely a neutral mechanism for maximizing satisfaction of those pref-
erences. Becker and Elias argue that organ sales should be liberalized
because legalization and regulation will lead to better social welfare poli-
cies for both sellers and patients. The advocates of an open market in
human organs usually base their position on the scarcity and the fact that
organ availability will not increase in the future. Friedman and Friedman
(2006) also support the idea of a regulated market arguing on financial
reasons, rather than access to health grounds. Along with others, they
say that payment for ‘donors’ should be legalized, since this would theo-
retically halt the financial exploitation of providers that currently pervades
the organ black market (Cherry 2005; de Castro 2003, 2014; Friedman
and Friedman 2006; Haris and Erin 2003; Jefferies 1998). Some liberal
22 F. NAHAVANDI
bioethicists have proposed that a regulated organ market would be an

efficient way to save the lives of dying patients. Cherry (2009, p. 360)
argues that some body parts, such as kidneys, are as a matter of fact com-
modities and that denying it, even while treating them as such, encour-
ages the continuation of dishonest public policy, and tends towards vice
rather than virtue. He argues against “the feelings of repugnance, conjur-
ing up nightmarish images of spare parts medicine” and “the apparent
global consensus, which holds such a market to be impermissible, if not
indefensible and therefore promoting worldwide prohibition”. Therefore,
he advocates an open market that would enhance a sense of community
and raise scientific standards, as well as increase individual freedom and
expression of altruism. His thesis is that prohibition of organ sales will
cause more harm than benefit. Michele Goodwin (2006) contends that
exclusive reliance on the present altruistic tissue and organ procurement
processes is not only rife with problems, but also improvident. She argues
that it will perpetuate organ shortages and an avoidable death rate for
patients, and therefore defends a hybrid model and an alternative vision
for the United States transplantation system. According to her, limited
market in body parts would not resemble slavery, and anti-market rhetoric
obscures the real challenges in procurement, including overcoming racial
and socioeconomic bias.
Among others, Radin (1987, 1996) has questioned the economic
neutrality of markets. In 2005, together with Sunder she argues “Markets
affect the rich and the poor differently. The poor are more likely to be
the sellers, and the rich, the buyers, of questionable commodities such
as sexual services or body parts. Unequal distributions of wealth make
the poorest in society, with little to offer in the marketplace, more likely
to commodify themselves—their bodies for sex, their reproductive capa-
bilities, their babies, and parental rights. Such ‘desperate exchanges’ raise
moral and legal concerns about the coercive nature of markets, and chal-
lenge the economists’ understanding of ‘voluntary market transactions’”
(Radin and Sunder 2005, p.11). Radin and Sunder also highlight the
way elites who use this reasoning are simply deepening the misery and
powerlessness of those who have nowhere to turn but to attempted sales
of their bodies, and interestingly, asks whether foreclosing markets to the
poorest in order to protect them harms them even more by denying them
a source of revenue, speaking of a “double bind” implicit in commodifi-
cation controversies (Radin and Sander 2005, p. 11–12). Radin suggests
an “incomplete commodification”, “an expression of a nonmarket order
coexistent with a market order” (Radin 1996, p. 113), and an interdisci-

plinary account of the changing subject and object of commodification,
bringing together both economic and cultural theorists under the same
roof, which would help to deconstruct both markets and culture, sepa-
rately, and to reconstruct them in relation to one another.
Some critics of commercial organ markets mobilize arguments such as
human dignity (Fox and Swazey 1992) or personhood (Holland 2001),
and develop troubled reactions to the expansion of organ replacement.
In what many consider a seminal work, Fox and Swazey (1992) criticize
various aspects of organ transplantation, including the routinization of
the procedure, ignorance regarding its inherent uncertainties, and the
ethos of transplant’s professionals. Others refer to sacredness of human
life (Ramsey 1992). The unscrupulous exploitation of the poor’s body
in the process is a core theme. Bioethicists have discussed the subject at
length. Dickenson’s idea is that the way the body is becoming an object of
commercialization is not inevitable (2008, 2012). Kimbrell (1993), who
has worked for eight years as the policy director at the Foundation for
Economic Trends, an organization that closely monitors the forces of bio-
technology, has been in the vanguard of those who oppose the patenting
of life, genetic engineering without appropriate safeguards, and the clon-
ing of animals and humans. He criticizes the relentless commodification of
the human body by people driven by the market ideology of self-interest,
and among others deals with and condemns the unregulated trafficking of
sperm, ova, frozen embryos, surrogate ‘motherhood’, and assisted repro-
ductive technology.
While anthropologists have been especially interested in the psycho-
logical adjustment of organ recipients, critical medical anthropologists
have focused more on donor issues (Ikels 2013). Medical anthropolo-
gists, such as Scheper-Hughes or Cohen (2001, 2003) have contributed
centrally to the scholarly discussion on organ trafficking. They usually
oppose commodifying body parts, arguing that it capitalizes on the
distress of those in need, particularly because as the poor can partici-
pate in such a system only as organ sellers, it is an exploitative practice.
Anthropologists also argue that certain living things should not be avail-
able for commercialization, as such a practice is carried out against cul-
ture and humanism in general (Fox and Swazey 1992; Joralemon 2000;
Sharp 2000, 2007; Tober 2007).
Radical legal theorists maintain that approaching the human body
in market terms confirms the subordinate status of disadvantaged social
24 F. NAHAVANDI
groups (MacKinnon 1991). Anti-market scholars also reject monetary

transactions, being concerned by religious belief, ethical thinking and
moral considerations (Wilkinson 2003).
Literature Related to the Working Cases

Literature on commodification of hair is not abundant (Carney 2011;
Berry 2008). Hair has more often been studied in historical and socio-
logical perspective, in postcolonial studies approaches and in link to black
women’s identity. One praiseworthy exception is Esther R. Berry’s work, in
which she argues that, “Exploring the lucrative business in locks teases out
important questions surrounding the politics of incommensurability and
the horror at a continuing colonialism rooted in the global marketplace”.
In her article, she uses the “zombie commodity as a theoretical tool to
deconstruct the politics of hair and its globalization” (Berry 2008, p. 73).
Literature on surrogacy has addressed the ethics of the practice (Anderson
1990; Andrews 1987), the increased medicalization of the process trans-
lated into commodification and technological colonization of the female
body (Corea 1986; Rothman 2000), the issue of exploitation and devalua-
tion of women (Blyth 2006; Ikemoto 2009), inequality at the global level
(Martin 2009; Storrow 2005), and more recently the impact of surrogacy
on the cultural meanings of motherhood and kinship (Markens 2007;
Pande 2009a, b, 2010a, b, c, 2011). Hudson et al. (2011) have detailed
the literature on what they call cross-border reproductive care in a critical
narrative overview. They highlight “significant methodological limitations
and gaps”. In turn, Smith et al. (2011) present a review of the literature
and analysis of the role of bilateral trade. On the brain drain, literature
from the 1960s and 1970s is abundant, as the process seemed worrisome
in many aspects for developing countries. From that time on, international
organizations have occupied the field. Two famous and often cited reports
are Docquier and Rapoport Report for World Bank (2008) and Lowell
and Findlay’s report for the International Labor Organization (2002).
(2002). Nowadays, the brain drain has re-entered the development debate
on a different ground: the race for power. Against the backdrop of a
highly competitive global knowledge economy, highly skilled migration is
becoming a major issue (Hartmann and Langthater 2009). The phenom-
enon, called today ‘attraction of brain’ is less addressed and is quite new in
literature (Bhagwati and Hanson 2009; Kapur and McHale 2005; Martin
et al. 2009; Shachar 2006, 2009, 2011; Shachar and Hirschl 2013; Xiang
Biao 2007). However, it has also become an ethical issue. “Our thesis is
that, although no immigration system is perfect ethically, politically, and
economically and notwithstanding its probable political unpopularity, sell-
ing citizenship does have advantages that remove some of the hypocrisy,
immorality, and disadvantages of existing policies” (Borna and Stearns
2002, p. 193). Moreover, migration is increasingly also considered in a
neoliberal market-driven perspective (Greenwood 2009; Lomborg et al.
2004) and discussed like other types of commodification (Adams 1968;
Becker 1987; Bhagwati 1976; Chiswick 1982; O’Shaughnessy 2000).
In the following chapters, in addition to some of the publications
referred to in this chapter, other works will be cited for each working case.
REFERENCES
Adams, W. (Ed.). (1968). The brain drain. New York: Macmillan.
Anderson, E. S. (1990). Is women’s labor a commodity. Philosophy and Public
Affairs, 19, 71–92.
Andrews, L. B. (1987). The aftermath of Baby M: Proposed state laws on surro-
gate motherhood. Hasting Centre Reports, 17, 31–40.
Appadurai, A. (1988). Introduction: Commodities and the politics of value. In
A. Appadurai (Ed.), The social life of things: Commodities in cultural perspective
(pp. 3–64). Cambridge: Cambridge University Press.
Becker, G. (1987). Why not let immigrants pay for speedy entry? In G. Becker &
G. Nashat-Becker (Eds.), The economies of life (pp. 58–60). New York:
McGraw-Hill.
Becker, G., & Elias, J. (2007). Introducing incentives in the market for live and
cadaveric organ donations. The Journal of Economic Perspectives, 21(3), 3–24.
Berry, E. (2008). The zombie commodity: Hair and the politics of its globaliza-
tion. Postcolonial Studies, 11(1), 63–84.
Bhagwati, J. N., & Hanson, G. (Eds.). (2009). Skilled immigration today: Prospects,
problems, and policies. Oxford and New York: Oxford University Press.
Bhagwati, J. N. (1976). The brain drain tax proposal and the issues. In J. N.
Bhagwati & M. Partington (Eds.), Taxing the brain drain. North-Holland:
Publishing Company.
Biao, X. (2007). Global ‘body shopping’, an Indian labor system in the information
technology industry. Princeton and Oxford: Princeton University Press.
Blyth, E. (2006). ‘Fertility tourism’ requires a social work response. The European
Social Worker, 3, 4.
Borna, S., & Stearns, J. M. (2002). The ethics and efficacy of selling national citi-
zenship. Journal of Business Ethics, 37(2), 193–207.
Carney, S. (2011). The red market. New York: William Morrow.
26 F. NAHAVANDI
Cherry, M. (2005). Kidney for sale by owner. Washington, DC: Georgetown

University Press.
Cherry, M. (2009). Embracing the commodification of human organs:
Transplantation and the freedom to sell body parts. Saint Louis University
Journal of Law & Policy, 2, 359–378.
Chiswick, B. R. (1982). The impact of immigration on the level and distribution
of economic well-being. In B. R. Chiswick (Ed.), The gateway: US immigration
issues and policies (pp. 289–313). Washington, DC: American Enterprise
Institute for Public Policy Research.
Cohen, L. (2001). The other kidney: biopolitics beyond recognition. Body &
Society, 7 (2-3), 9–29.
Cohen, L. (2003). Where it hurts: Indian materials for ethics of organ transplant.
Zygon, 38(3), 663–688.
Corea, G. (1986). The mother machine: Reproductive technologies from artificial
insemination to artificial wombs. New York: Harper and Raw.
Cuthbert, D., & Fronek, P. (2014). Perfecting adoption? Reflections on the rise of
commercial offshore surrogacy and family formation in Australia. In A. Hayes
(Ed.), Families, policy and the law (pp. 55–66). Melbourne: Australian Institute
of Family Studies.
De Castro, L. D. (2003). Commodification and exploitation: Arguments in favour
of compensated organ donation. Journal Medical Ethics, 29, 142–146.
De Castro, L. D. (2014). Organ donation in the Philippines: Should the dead do
more? Indian Journal of Medical Ethics, 11(3), 143–150.
Desclaux, A. (2006). L’utilisation du corps humain à des fins thérapeutiques en
Occident. Bulletin Amades, 67. Retrieved September 11, 2014, from http://
amades.revues.org/337
Dickenson, D. (2008). Body shopping, converting body parts to profit. Oxford:
Oneworld Publications.
Dickenson, D. (2012). Bioethics. London: Hodder Education.
Docquier, F., & Rapoport, H. (2008). Skilled migration, the perspective for devel-
oping countries. World Bank Policy Research Paper no 3382, 2007. Retrieved
January 13, 2015, from http://web.mit.edu/is08/pdf/rapoport.pdf
Ertman, M., & Williams, J. (Eds.). (2005). Rethinking commodification, cases and
readings in law and culture. New York: New York University Press.
Foucault, M. (1994). The birth of the clinic: An archeology of medical perception.
New York: Vintage Books. First published in French 1963.
Foucault, M. (1995). Discipline and punish: The birth of the prison. New York:
Vintage Books. First published in French 1975.
Fox, R. C., & Swazey, J. P. (1992). Spare parts: Organ replacement in American
society. New York: Oxford University Press.
Friedman, E., & Friedman, A. (2006). Payment for donor kidney: Pros and cons.
Kidney International, 69, 960–962.
Goodwin, M. (2006). Black markets, the supply and demand of body parts.
New York: Cambridge University Press.
Greenwood, M. (2009). Population: Migration. In B. Lomborg (Ed.), Solutions to
the world’s biggest problems: Costs and benefits (pp. 425–439). Cambridge:
Cambridge University Press. 2007.
Greil, A. L. (1991). Not yet pregnant: Infertile couples in contemporary America.
New Brunswick: Rutgers University Press.
Haris, J., & Erin, C. A. (2003). An ethical market in human organs. The Journal
of Medical Ethics, 29(3), 137–138.
Hartmann, S., & Langthater, M. (2009). The race for the best: A European perspec-
tive on the brain drain. Social Watch Annual Report. 15–18. Retrieved January
13, 2015, from http://www.socialwatch.org/sites/default/files/ESW2009_
ofse_eng.pdf
Holland, S. (2001). Contested commodities at both ends of life: Buying and sell-
ing gametes, embryos, and body tissues. Kennedy Institute of Ethics Journal,
11(3), 263–284.
Hudson, N., et al. (2011). Cross-border reproductive care: A review of the litera-
ture. Reproductive Biomedicine Online, 23, 673–685.
Hurley, R. (1995). Human tissue: Ethical and legal issues. London: Nuffield
Council on Bioethics.
Ikels, C. (2013). The anthropology of organ transplantation. Annual Review of
Anthropology, 42, 89–102.
Ikemoto, L. C. (2009). Reproductive tourism: Equality concerns in the global
market for fertility services. Law Inequality, 27, 277–309.
Inhorn, M. C., & Patrizio, P. (2009). Rethinking reproductive ‘tourism’ as repro-
ductive ‘exile’. Fertility and Sterility, 92, 904–906.
Jefferies, D. E. (1998). The body as commodity: The use of markets to cure the
organ deficit. Global Legal Studies Journal, 5(2), 621–658.
Joralemon, D. (1995). Organ wars: The battle for body parts. Medical Anthropology
Quarterly, 9, 335–336.
Joralemon, D. (2000). The ethics of the organ market: Lloyd R. Cohen and the
free marketeers. In P. E. Brodwin (Ed.), Biotechnology and culture: Bodies, anxi-
eties, ethics (pp. 224–237). Indianapolis: Indiana University Press.
Kant, E. (1981) Grounding for a metaphysic of morals. Indianapolis. Hackett. First
published in Geramn in 1785.
Kapur, D., & Mchale, J. (2005). Give us your best and brightest, the global hunt for
talent and its impact on the developing world. Washington, DC: Center for
Global Development.
Kimbrell, A. (1993). The human body shop, the engineering and marketing of life.
San Francisco: Harper Sanfrancisco.
28 F. NAHAVANDI
Knoppers, B.-M., & Lebris, S. (1991). Recent advances in medically assisted con-
ception: Legal, ethical and social issues. American Journal of Law & Medicine,
17, 239–361.
Kopitoff, I. (1988). The cultural biography of things, commoditization as process.
In A. Appadurai (Ed.), The social life of things: Commodities in cultural perspec-
tive. (pp. 64–95). Cambridge: Cambridge University Press.
Locke, J. (1980). The second treatise on civil government. London. Hackett. First
published in 1689.
Lomborg, B., et al. (Eds.) (2004). Global crises, global solutions. Cambridge:
Cambridge University Press.
Lowell, L. B., & Findlay, A. (2002). Migration of highly skilled persons from devel-
oping countries: Impact and policy responses. A Project Report for the
International Labor Office and the United Kingdom’s Department for
International Development. Geneva: ILO. Retrieved January 8, 2014, from
http://www.ilo.org/public/english/protection/migrant/publ/imp-list.htm
Mackinnon, C. A. (1991). Toward a feminist theory of state. Cambridge: Harvard
University Press.
Markens, S. (2007). Surrogate motherhood and the politics of reproduction. Berkeley:
University of California Press.
Martin, L. J. (2009). Reproductive tourism in the age of globalization.
Globalizations, 6(2), 249–263.
Martin, S., et al. (2009). Skilled immigration to America. In J. Bhagwati &
G. Hanson (Eds.), Skilled immigration today: Prospects, problems, and policies
(pp. 131–153). Oxford and New York: Oxford University Press.
Marway, H., Johnson, S. L., & Widdows, H. (2014). Commodification of human
tissues. In H. Have & B. Gordijin (Eds.), Handbook of global bioethics (pp. 581–
598). Retrieved October 25, 2014, from http://philpapers.org/archive/
MARCOH-2.pdf
Marx, K. (1875). The Capital, Vol. I, Part 1, Chapter one: Commodities, section
1. Retrieved September 13, 2014, from https://www.marxists.org/archive/
marx/works/1867-c1/ch01.htm. First published in German in 1867.
Matorras, R. (2005). Reproductive exile versus reproductive tourism. Human
Reproduction, 20, 35–71.
Mauss, M. (1967). The gift: Forms and functions of exchange in archaic societies.
New York: Norton. First published in French in 1925.
O’Shaughnessy, J. (2000). Treating the nation as a brand: Some neglected issues.
Journal of Macromarketing, 20(1), 56–64.
Pande, A. (2009a). Not an ‘angel’, not a ‘whore’: Surrogates as ‘dirty’ workers in
India. Indian Journal of Gender Studies, 16(4), 141–173.
Pande, A. (2009b). It may be her eggs, but it’s my blood: Surrogates and everyday
forms of kinship in India. Qualitative Sociology, 32(4), 379–397.
Pande, A. (2010a). At least I am not sleeping with anyone: The stigma of com-
mercial surrogacy. Indian Feminist Studies, 36, 292–314.
Pande, A. (2010b). Commercial surrogacy in India: Manufacturing a perfect
mother-worker. Signs, 35(4), 969–992.
Pande, A. (2010c). Commercial surrogacy in India: Manufacturing a perfect
mother-worker. Signs: Journal of Women in Culture and Society, 35, 969–994.
Pande, A. (2011). Transnational commercial surrogacy in India, gifts for global
sisters? Reproductive BioMedicine Online, 23, 618–625.
Parry, B. (2008). Entangled exchange: Reconceptualising the characterisation and
practice of bodily commodification. Geoforum, 39, 1133–1144.
Pfeffer, N. (2011). Eggs-ploiting women: A critical feminist analysis of the differ-
ent principles in transplant and fertility tourism. Reproductive Biomedicine
Online, 23(5), 634–641.
Radin, M. J. (1987). Market-inalienability. Harvard Law Review, 100,
1849–1937.
Radin, M. J. (1996). Contested commodities: The trouble with trade in sex, children,
body parts, and other things. Cambridge: Harvard University Press.
Radin, M. J., & Sunder, M. (2005). Introduction: The subject and object of com-
modification. In M. Ertman & J. Williams (Eds.), Rethinking commodification:
Cases and readings in law and culture (pp. 8–34). New York: University of
New York Press.
Ramsey, P. (1992). The patient as person. New Haven: Yale University Press.
Rosewarne, S. (2010). Globalisation and the commodification of labour, tempo-
rary labour migration. The Economic and Labour Relations Review, 20(2),
99–110.
Rothman, B. (2000). Recreating motherhood. New Brunswick: Rutgers University
Press.
Scheper-Hughes, N. (2005, January-February 26–27). Organs without borders.
Foreign Policy, 146.
Scheper-Hughes, N. (2000a). The global traffic in human organs. Current
Anthropology, 41(2), 191–224. Retrieved January 5, 2014, from http://pascal-
froissart.free.fr/3-cache/2000-scheperhughes.pdf.
Scheper-Hughes, N. (2000b). Commodification of the body and its parts. Annual
Review of Anthropology, 29, 287–328.
Scheper-Hughes, N. (2001a). Body for sale-whole or in parts. Body & Society,
7(1), 1–8.
Scheper-Hughes, N. (2001b). Commodity fetishism in organs trafficking. Body &
Society, 7(2–3), 31–62.
Scheper-Hughes, N., & Roberts, E. (2011). Introduction: Medical migrations.
Body and Society, 17(2–3), 1–30.
Shachar, A. (2006). The race for talent: Highly skilled migrant and competitive
immigration regimes. University of Toronto Legal Studies Series, Research
Paper: 883739. 101–158.
30 F. NAHAVANDI
Shachar, A. (2009). The birthday lottery, citizenship and global inequality.

Cambridge: Harvard University Press.
Shachar, A. (2011). Picking winners: Olympic citizenship and the global race for
talent. The Yale Law Journal, 120, 2088–2139.
Shachar, A., & Hirschl, R. (2013). Recruiting ‘super talent’: The new world of
selective migration regimes. Indiana Journal of Global Legal Studies, 20(1),
71–107.
Sharp, L. (2000). Commodification of the body and its parts. Annual Review of
Anthropology, 29, 287–328.
Sharp, L. (2006). Strange harvest: Organ transplants, denatured bodies, and the
transformed self. Berkeley and Los Angeles: University of California Press.
Sharp, L. (2007). Bodies, commodities, and biotechnologies: Death, mourning, and
scientific desire in the realm of human organ transfer. New York: Columbia
University Press.
Shimazono, Y. (2007). The state of international organ trade: A provisional pic-
ture based on integration of available information. Bulletin of the World Health
Organization, 85(12), 955–962.
Smith, R., et al. (2011). A review of the literature and analysis of a role for bilateral
trade. Health Policy, 103, 276–282.
Storrow, R. F. (2005). The handmaid tale of fertility tourism: Passports and third
parties in the religious regulation of assisted conception. Texas Wesleyan Law
Review, 12, 189–211.
Titmuss, R. (1997). The gift relationship: From human blood to social policy.
London: New Press. First published 1970.
Tober, D. (2007). Kidneys and controversies in the Islamic Republic of Iran: The
case of organ sale. Body & Society, 13(3), 151–170.
Triadafilopoulos, P., & Ohliger, R. (Eds.). (2013). Wanted and welcome? Policies
for highly skilled immigrants in comparative perspective. New York: Springer.
Waldby, C., & Mitchell, R. (2006). Tissue economies, blood, organs, and cell lines in
late capitalism. Durham and London: Duke University Press.
Watters, E. (2014). The organ detective: A career spent uncovering a hidden global
market in human flesh. Retrieved September 14, 2014, from http://www.
psmag.com/navigation/business-economics/nancy-scheper-hughes-black-market-
trade-organ-detective-84351/
Whittaker, A. (2011). Cross-border assisted reproduction care in Asia: Implications
for access, equity and regulations. Reproductive Health Matters, 19(37),
107–116.
Wildavsky, B. (2010). The great brain race: How global universities are reshaping
the world. Princeton: Princeton University Press.
Wilkinson, S. (2003). Bodies for sale: Ethics and exploitation in the human body
trade. London: Routledge.
CHAPTER 3
Transnational Hair Trade
Abstract For many people, beautiful hair is a badge of beauty. Both wealthy
consumers and people from less affluent classes from all over the world are
eager to pay an enormous price to fulfill their dreams of beauty using either
wigs or hair extensions. A modern trend is to use natural hair, which all the
facts show comes mostly from developing countries, where the women are
poor enough to consider selling a treasured possession. The demand has
turned the hair trade into a profitable business whereas it has also given way
to all sorts of trafficking. Nahavandi argues that this process can be consid-
ered as the extraction of a new type of resource from the Global South.
Keywords Natural hair • Wigs • Hair extension • Feminity • Identity •

Class • Black woman • Business • Poverty • India
HAIR AS A COMMODITY
The trade and use of natural or artificial hair is not new phenomena. They
reflect an early commodification of a human body part together with an
early example of the appropriation of a resource extracted from the weak
by the powerful. Indeed, recourse to wigs traces back to ancient times,
and was already known in Egypt. In the most powerful social classes, it
was common to use wigs together with hair extensions. Ancient civili-
zations such as Assyrians, Phoenicians, Greeks and Romans all used
wigs to enhance their hairstyles. In Rome, examples of elegant people,
adorned with a blond wig almost always made of natural hair obtained

DOI 10.1057/978-1-137-50584-2_3
32 F. NAHAVANDI
from German and Nordic slaves further illustrate the appropriation of a

body part of the weak. However, the demand progressively disappeared
as blond wigs became the trademark of prostitutes in Rome. Their use
was denounced by early Fathers of the Church as an invention of the devil
unworthy of Christianity, and a serious offense to God signaling debauch-
ery and lewdness,. This view was applied during several centuries until the
Renaissance when wigs became considered a sign of status and provided
the ability to engage in conspicuous consumption. The recourse to wigs
by kings and their court such as Louis XIV’s in France illustrates this evo-
lution. The practice was again largely abandoned in the newly created
United States and France by the start of the 19th century. Meanwhile,
by the eighteenth century in Western Europe wigs became smaller and
more formal and mainly adopted by different professions as an element
of their uniform. More recently, in the 1960s, the resurgence of hair in
women’s fashion grew through the development of cheap synthetic fibers
(Woodford 1972). Currently, while wigs are still in use, hair extensions
are dominating the hairpiece industry. They have become an accessory
of beauty. Natural or artificial, hair extension is common today; however,
natural hair is favored. It still indicates the consumers’ wealth together
with their purchasing power. Costly natural hair is mostly coming from
the Global South, as the markets are fuelled with cheaply bought hair from
poor women themselves, or more often from unscrupulous intermediar-
ies, treated and then sold at a considerable profit, as will be addressed later.
Notwithstanding, the twentieth century provides cases of more hei-
nous and revolting use of hair (Gutman and Berenbaum 1994, Arnett
2015; Curry 2010, Langbein 2014). In concentration camps during the
Nazi period, prisoners were shaved and their hair sent to textile factories.
In a way, concentration camps were a paroxysmal example of use of the
human body where looting was added to persecution and death, a total
commodification of the human body: forced labor, hair, bones, teethe and
skin. In Auschwitz, between April 1, 1942 and December 1943, three
tons of women’s hair were extracted and sent to Germany. They were sold
for 0.50 mark per kilo to the Alex Zink felt factory near Nuremberg. At
liberation, around 7000 kilos of hair were discovered at that site.
THE DEMAND
Nowadays, recourse to natural hair is becoming normalized. The demand
for hair is fueled by its persistent role in women’s identity, characteristics of
previous times, together with the generalization of new global standards
TRANSNATIONAL HAIR TRADE 33
of beauty. For many people, as stated in an advertisement, “the quality

of life depends on the quality of your hair” (Miller 1998, p. 259) and in
the Global North beauty salons, women may pay as much as $4000 for a
longer, thicker head of hair (Stillson 2009). The latter has become a badge
of beauty, if not good health while the business of hair is even presented
as contributing to the development of poor countries: “So you see what is
considered as hi-fashion in the West provides food, shelter and job security
to poor Indian families” (Blackgold Impex 2015).
The explosion in the popularity of extensions is also largely due to
endorsements from celebrities in a highly mediatized society. As a result,
both wealthy consumers and sometimes people from less affluent classes
from all over the world are eager to pay an enormous price to fulfill their
dreams of beauty using either wigs or hair extensions. In Africa, straight hair
becomes a matter of ‘survival’ when it is the condition to getting a job or
finding a husband. Consequently, in that continent, the cost of extensions
and wigs can be staggering, ranging from $10 a-piece for synthetic hair to
as much as $800 and upwards for human hair pieces (Emelumadu 2009).
Yet it does not seem to deter women bent on achieving perfect flowing
locks. No longer a luxury for only the rich and famous, extensions using
human hair are now available everywhere. In supermarkets, especially in
the United States, the ethnic hair care sections are expanding. Overall, the
approach of multicultural marketing is growing. Purpose-driven market-
ing is an effective and important strategy for connecting with multicultural
consumers (Warner 2012). Further, in addition to beauty, advertisements
for natural hair integrate a health factor: “We believe in empowering our
clients to sustain exceptional, long-term hair beauty and health. There
are archetypes in our society about what beautiful hair looks like and that
is what fuels this natural-or-not dilemma. If people of color decide to
use hair relaxers, for example, then serious health implications can result
such as permanent scalp damage. If people of color decide to go natural,
then they are subject to being stereotyped as too left of center politically,
socially, or both. We empower our clients to escape this dilemma by being
the best at our craft and offering a healthy medium” (Kacolema 2013).
More than ever, beauty has become a global industry using flattery, seduc-
tion, science and shame to persuade consumers that they have to invest if
they want to look their best (Tungate 2011) and head hair is an important
component of it.
Today, transportation facilities together with the progress in technol-
ogy and science, market-oriented economy and a consumer society have
34 F. NAHAVANDI
created the opportunity to develop a booming industry around head hair,

especially as it has always been an important symbol for women and soci-
eties. Indeed, amidst the power of advertising and fashion hairstyle, as
well as the clothes we wear, has always had a social meaning assigned by
popular culture of the time (Manning 2010, p. 35). Hair is a social con-
struct that is deeply connected to women’s identities (Weitz 2004, p. 29);
it is perhaps the most powerful symbol of individual and group identity
(Synott 1987). For women and girls, hair can be the primary way in which
their identity is declared to those they meet. They are mostly socialized
to accept this connection to hair at an early age and develop an emotional
attachment to it (Weitz 2004). Nevertheless, women may not only use
their hair to establish a group identity, but also as a form of everyday resis-
tance to social norms established by dominant culture. For example, they
may cut it short where and when long hair is the norm. Female head hair
is also often intimately tied up with the performance of femininity, and
with life-course transformations. It has been central to the mythologies
and religious traditions. Most patriarchal religions have, at least at some
point, required women to cover their hair with veils or hats, the reasoning
usually being that women’s long hair is sensual and a source of temptation.
Furthermore, historically and still today, clothing and head hair have also
served as a means of displaying or revealing one’s religious views (Sherrow
2006). Hair has the power to signal woman’s socioeconomic class (Bettie
2000, 2003). In sum, the way women in particular wear their hair has
always had social significance and it intersects, among others, with race,
gender and identity. “Women struggle not only with what it means to be
female but also what it means to be white, black, or Hispanic; straight or
lesbian; working class or middle-class, and so on” (Weitz 2004, p. 29).
Black women are an important consumer group for the hair industry
since for them hair transcends a cosmetic or esthetic issue because it is at
the base of their identity historically, culturally and socially. Hair shapes
black women’s ideas about race, gender, class, sexuality, images of beauty
and power (Banks 2000). Wendy Cooper (1971), highlights skin and hair
are the most important physical attributes for racial classification. Orlando
Patterson (1982) argues that hair type rapidly became the real symbolic
badge of slavery. As a result, “What might seem like vanity to some can
in fact boil down to survival for many women in Africa, when careers
and incomes rely on one’s hairstyle. In Kenya, for example, a woman
with a natural look or dreadlocks is unlikely to succeed at job interviews”
(Emelamadu 2009). For Nigerian women, straight hair is the ultimate
status symbol and many go to beauty salons to get long bone-straight

extensions (Mark 2011).
As the demand for hair extensions has exploded over the last decade,
wherever the origin, the human hair trade has become an attractive busi-
ness. In Britain, sales are up to $107 million a year and growing (Khaleeli
2012). “The global market for human hair tops out at almost $ 900 mil-
lion in sales, and that doesn’t include the installation costs that salons
charge” (Carney 2011, p. 223). The human hair trade has spread across
the globe with the United States, China and the United Kingdom as the
biggest importers of human hair in the world (Turner 2011). China is
also the very first exporter of human hair product, as well as the main
place for the treatment of hair—coming from mostly India, Indonesia and
Vietnam—before export (Doan Bui 2011).
THE SUPPLY
In modern days, hair type is the distinguishing factor in human hair wigs
and extensions. Four main types of natural hair are used in manufacturing:
Chinese or Malaysian, Indian, Indonesian or Brazilian, and Caucasian or
European. The latter is considered the most expensive and rare, as most
sellers originate from Russia or Northern Europe, where there are few hair
sellers in the market. However, in the global market, the majority of hair
comes from India (Pomfret 2003). Therefore, natural hair mostly comes
from the Global South, where long natural hair remains a badge of beauty
and has all the social meanings highlighted in the above section, but where
there is a high percentage of women who are poor enough to consider
selling a treasured possession. In that environment, hair sale has become
a way of making ends meet. Even though Indian hair is the most appreci-
ated, every crisis adds more sellers to the global market. For example, in
2012, many of the women evicted from Phnom Penh’s Borei Keila slum
resorted to hair sale, sometimes for no more than $8, after losing their
homes and jobs in one of Cambodia’s recent bitterest land disputes (The
Phnom Penh Post 2012). The main motivation was buying rice for the
family.
In Great Britain, hair extensions usually come from India, as Indian
women’s hair quality is closer to Westerns women than all Asian women’s.
That is the case at Great Lengths Hair extension, which consists of more
than 1000 salons in the United Kingdom, and has reported a staggering
70 percent growth in the past five years (Great Lengths). Moreover, Indian
36 F. NAHAVANDI
hair is particularly appreciated, as it is ‘virgin’ and not altered by coloring

or treatment. This is what the company advertises: “Great Lengths utilizes
100% human hair of the best quality. This is Indian Temple Remi hair (all
hair cuticle facing the same direction) and in virgin condition. Genetically,
Indian hair is very similar to Caucasian hair in its basic structure. It is of
extraordinary quality since it has never been exposed to harsh chemical
treatments. Indian Temple hair is optimal for the employment of quality
hair extensions, but only makes financial sense to purchase if the subse-
quent treatments necessary to create all colors will not damage this supe-
rior quality hair ” (Great Lengths).
In India, the business is also facilitated by religious customs, in which
in order to fulfill a wish or to purify themselves, Indians shave their hair
in temples. This hair is called ‘temple hair’, and temple employees call it
black gold (Carney 2011, p. 224). The process is called tonsuring. Every
day tens of thousands of Hindus make pilgrimages to the country’s biggest
temples. Many have no money to offer the gods; the most valuable thing
they can give is their hair. This custom has now formed the business end of
a lucrative and fast-growing supply chain. Accordingly, every day 20,000
persons donate their hair which temples then sell to enterprises special-
izing in hair extension for $200 to $300 per kilogram. In the past, temple
hair was burned or used to stuff mattresses. Therefore, temple hair is now
a valuable commodity and demand has turned faith into fashion and busi-
ness. Nevertheless, “the Indian temples together contribute only 20 out
of every 100 locks of premium hair sold abroad” (McDougall 2006). The
remaining comes from individual sellers. Furthermore, The Observer has
uncovered evidence that village women across India are being increasingly
targeted for their sought-after waist-length tresses, mainly by unscrupu-
lous agents hired by small-time exporters who, in an attempt to bypass
the Hindu temples’ monopoly in the market, are offering husbands less
than $10 each for their wives’ hair and, in more extreme circumstances,
forcing women to shave their heads, a practice that can be traumatizing
(McDougall 2006) in a country where, according to tradition and mean-
ing of hair, cutting and shaving hair can also be considered as cultural
sacrilege or self-amputation.
The Indian hair exporters earn combined revenues of approximately
$300 million each year (McDougall 2006). “The export of the long
hair from India was very big business in the 1960s and the demand was
so much so that the prices kept on climbing to a very high level since
the quantity of supply was limited. In 1970 the Japanese found out the
Synthetic Hair which was much cheaper and which can be manufactured
to any length you desire. With the result the entire market for Natural
Human Hair collapsed for the next 10 years. In the Mid 80s people after
using the Synthetic Hair for a long time came to realize that the Natural
Human Hair even though expensive is far better in quality and in comfort
for wigs and extensions etc. So the demand for natural hair started picking
up” (Raj Hair International).
In Vietnam, the hair trade is also becoming an attractive business, espe-
cially in poor rural areas where, because of the huge profits it can bring, a
large number of farmers are engaged in this activity, eager to improve the
lives of their families. It is particularly the case of the northern province
of Bac Ninh where the traditional farming area has been transformed due
to the sale of hair (Daily News 2012). However, in Vietnam, contrary
to India, poverty is the prime reason of selling with no religious reasons
underlying the transaction. The price per kilogram varies from $45 to $
250 depending on the quality of the hair—with long, natural hair being
the most prized for extensions. And, as in India, it produces sorrow for
having sold a treasured asset.
In Myanmar, where long hair is considered the natural complement to
traditional dress, women are also increasingly cutting and selling their hair
to support their family (Muditt 2013). Some of them do it secretly due
the dignity associated with long hair. Therefore, hair sale has become a
way of compensating the lack of income. It particularly increases in June,
when mothers have to pay the school fees, and when the rainy season
forces families in rural areas to search for alternative sources of income.
In turn, a hair trader can earn more than an average teacher. For exam-
ple, in Rangoon, 1.6 kilograms of hair can be sold up for up to $400
(Social Watch Report 2007). However, some hair sales in Myanmar may
also support bridge or road constructions or fund social activities in poor
communities.
The huge demand of hair has also given way to all sorts of traffick-
ing and illegal trade. In Brazil, hair attack is growing. In Russia, there is
evidence of prisoners’ heads being forcibly shaved and the hair sold. In
Myanmar, rising incidents of women’s hair being cut off at crowed places
are reported (IOL News 2007). Gangs in Johannesburg mug people for
dreadlocks and ‘hair jacking’ is spreading (Fihlani 2013). In Vietnam,
unscrupulous hair hunters reportedly attacked female students at a school
in Lang Son province, near the Chinese border, and forcibly hacked off
their flowing tresses Daily News 2012, Dandberg 2008.
38 F. NAHAVANDI
To conclude, clearly, the intersection of factors such as identity, class

and race together with market advertisement and the Western cultural
construction of beauty have contributed to the booming natural hair
industry. The latter fuels a new appropriation of resources from develop-
ing countries in which poor women sell a treasured and socially valued
possession in favor of other women, mostly more well off. Therefore, the
Global South’s female body has become part of multidirectional and inter-
sected global flows, forming a reality in which female consumers use locks
of strangers to fill in a perceived bodily shortcoming (Berry 2008, p. 68).
Moreover, hair extension illustrates the process by which the citizen-
consumers of the global market depend on the definition and disciplining
of producers-workers on whose backs the citizen-consumer gains legiti-
macy (Mohanty 1997). Finally, the transnational trade of human hair can
also be considered as “a business in body parts, multiple strands that con-
tribute to global capitalism’s exploitation of Third World women and their
labor” (Berry 2008, p. 80).
REFERENCES
Arnett, G. (2015). Auschwitz: A short history of the largest mass murder site in
human history. The Guardian, January 27.
Banks, I. (2000). Hair matters, beauty, power, and black women’s consciousness.
New York and London: New York University Press.
Berry, E. (2008). The zombie commodity: Hair and the politics of its globaliza-
tion. Postcolonial Studies, 11(1), 63–84.
Bettie, J. (2000). Women without class: Chicas, Cholas, Trash and the presence/
absence of identity. Signs: Journal of Women in Culture and Society, 26, 1–35.
Bettie, J. (2003). Women without class: Girls, race, and identity. Berkeley: University
of California Press.
Blackgold Impex. (2015). Is it business or religion that drives the human hair
trade? Retrieved July 20, 2015, from http://www.blackgoldimpex.com/blog/
is-it-business-or-religion-that-drives-the-human-hair-trade/
Cooper, W. (1971). Hair, sex, society, and symbolism. London: Aldus Books.
Curry, A. (2010) Can Auschwitz be saved? Smithsonian.com, February. Retreived
December 15, 2014, from http://www.smithsonian.com
Daily News. (2012, October 15). In Vietnam, human hair is big business. Retrieved
June 10, 2014, from http://www.nydailynews.com/life-style/fashion/
vietnam-women-improve-lot-selling-hair-article-1.1183741
Doan Bui. (2012, October 15). In Vietnam human hair is big business. Daily News.
Retrieved December 16, 2014, from http://www.nydailynews.com/life-style/
fashion/vietnam-women-improve-lot-selling-hair-article-1.1183741; http://
tempsreel.nouvelobs.com/economie/20110119.OBS6519/reportage-l-
empire-du-cheveu.html
Emelumadu, Ch. (2009, October 30). The good, the bad, and the ugly hair days.
BBC News. Retrieved September 20, 2014, from http://news.bbc.co.uk/2/
hi/africa/8330482.stm
Fihlani, P. (2013, February 27). South Africa’s dreadlocks thieves. BBC News.
Retrieved September 20, 2014, from http://www.bbc.com/news/
world-africa-21498878
Gutman, Y., & Berenbaum, M. (Eds.). (1994). Anatomy of the Auschwitz death
camp. Bloomington: Indiana University Press.
IOL News. (2007, May 13). Long-haired women face threat of hair thieves.
Retrieved September 20, 2014, from http://www.iol.co.za/news/world/
long-haired-women-face-threat-of-hair-thieves-1.352744#.VB1Ih-coDaJ
Kacolema. (2013). Local business addresses growing demand for “natural hair”
services in Saint Louis. Retrieved September 20, 2014, from http://interact.
stltoday.com/pr/business/PR053113031313152
Khaleeli, H. (2012, October 28). The hair trade dirty business. The Guardian.
Retrieved February 1, 2014, from http://www.theguardian.com/lifeand-
style/2012/oct/28/hair-extension-global-trade-secrets
Langbein, H. (2004). People on Auschwitz. USA, The University of North
Carolina Press.
Manning, Y. (2010). The sociology of hair: Hair symbolism among college stu-
dents. Social Sciences Journal, 10, 35–48.
Mark, M. (2011, December 16). Curls allowed? No, say Nigerian women who
give it to you straight. The Guardian. Retrieved July 20, 2015, from http://
www.theguardian.com/world/2011/dec/16/curls-nigerian-women-straight
Mcdougall, D. (2006, June 25). Trade hair forces Indian children to pay the price.
The Observer. Retrieved April 18, 2014, from http://www.theguardian.com/
world/2006/jun/25/india.theobserver
Miller, B. (1998). The disappearance of the oiled braid: Indian adolescent female
hairstyles in North America. In A. Hiltebeitel & B. Miller (Eds.), Hair: Its
power and meaning in Asian cultures (pp. 259–281). Albany: State University
of New York Press.
Mohanty, C. T. (1997). Women workers and capitalist scripts: Ideologies of domi-
nation, common interests, and the politics of solidarity. In M. J. Alexander &
C. T. Mohanty (Eds.), Feminist genealogies, colonial legacies, democratic futures
(pp. 3–29). New York: Routledge.
40 F. NAHAVANDI
Muditt, J. (2013, August 25). Hair strands from the streets stands a tangled suc-
cess. Bangkok Post. Retrieved June 20, 2015, from http://www.bangkokpost.
com/print/366268/
Patterson, O. (1982). Slavery and social death. Cambridge: Harvard University
Press.
Pomfret, J. (2003, December 26). China has locks on unusual niche: Human hair
industry is world leader. Washington Post. Retrieved October 10, 2013, from
http://www.highbeam.com/doc/1P1-88845642.html
Sandberg, B. (2008). Globalization’s personal link: Hindu locks keep human hair
trade humming. Spiegel Online International, 18 February. Retrieved
September 28, 2014, from http://www.spiegel.de/international/business/
globalization-s-personal-link-hindu-locks-keep-human-hair-trade-hum-
ming-a-536349-2.html
Sherrow, V. (2006). An encyclopedia of hair: A cultural history. Westport:
Greenwood Press.
Social Watch Report. (2007). In dignity and rights, making the universal right to
social security a reality. Retrieved July 31, 2015, from http://www.socialwatch.
org/sites/default/files/pdf/en/burmaoverview2007_eng.pdf
Stilson, J. (2009). Documentary: Good hair.
Synott, A. (1987). Shame and glory: A sociology of hair. The British Journal of
Sociology, 38(3), 381–413.
The Phnom Penh Post. (2012). Sell hairs for a bowl of rice. 18 July. Retrieved July
1, 2015, from http://www.ccfcambodge.org/en/single-news/n/sell-hairs-
for-a-bowl-of-rice/
Tungate, M. (2011). Branded beauty, how marketing changed the way we look.
London and Philadelphia: Kogan Page Publishers.
Turner, L. (2011, August 3). Human hair trade soars on celebrity hairdo envy.
Reuters. Retrieved December 5, 2013, from http://www.reuters.com/arti-
cle/2011/08/03/us-human-hair-trade-idUSTRE7723U520110803
Warner, J. T. (2012). Profit with purpose. New York: Paramount Market Publishing.
Weitz, R. (2004). Rapunzel’s daughters: What women’s hair tells us about women’s
lives. New York: Farrar, Strauss and Giroux.
Woodford, J. (1972). The strange story of false hair. New York: Drake Publishers.
CHAPTER 4
Transnational Surrogacy
Abstract Chapter 4 offers an overview of the complex motivations that

underlie the demand for a child, and the recourse to surrogacy, together
with the situations that encourage the Global South’s women to rent out
their womb. Poverty remains the key factor. Nahavandi argues that even
though surrogacy is one of the genuine advances in modern biomedicine,
it has been turned into a big business, reflecting a world where increas-
ingly everything can be outsourced. In this process, wealthier people from
the Global North in particular are using women’s bodies in the Global
South’s as a resource. The chapter considers some of the key countries
where surrogacy is increasingly offered.
Keywords Child desire • Adoption • Surrogacy • Baby factory • India •

Thailand • Poverty • Commissioner • Gestational carrier • Poverty
Surrogacy is an arrangement in which a woman ‘agrees’—usually under a

contract—to become pregnant and deliver a child for another party It is
another example whereby women’s body parts are becoming commod-
itized, in this case, to give birth for usually wealthy couples or individu-
als. Nowadays, recourse to the Global South’s women’s body is getting
normalized, and commissioning and transnational reproduction travels are
increasingly becoming signs of a stratified reproduction process (Hudson
et al. 2011; Collen 1995; Anderson 1990). Surrogacy is one part of

DOI 10.1057/978-1-137-50584-2_4
42 F. NAHAVANDI
the transnational reproduction trade; it can also include, in one way or

another, activities such as donation or selling gametes, sex selection and
embryonic diagnosis.
THE WOMB AS A COMMODITY

In 1978, the first baby conceived by in vitro fertilization (IVF) or assisted
reproductive technologies (ART), was born in England. Shortly after, the
first recorded donor-egg conceived child was born in California. In the late
1980s, ultrasound-guided egg retrieval became available and the infertility/
fertility industry progressively expanded (Andrews 1987, Pfeffer (2011).
Two forms of surrogacy coexist: traditional or genetic surrogacy, in which
the surrogate woman is the egg supplier in addition to the carrier of fetus;
and gestational surrogacy, by way of which other actors participate in the
birth of a child. An embryo is created through IVF using the egg and/or
sperm of the intended parents or of third parties, and then implanted in the
surrogate. In the latter, the resulting child is genetically unrelated to the
surrogate. Therefore, nowadays, baby production can be considered as glo-
balized: an egg donor from one country, a sperm donor from another, and
a surrogate who will deliver in a third country. In this sense, notes Nayak
(2014), surrogacy has not only moved beyond geographic boundaries, but
has also significantly delinked biology from reproduction. “It could shift the
cultural meaning of ‘to mother’ making it more biological, discontinuous,
and distant” (Wolifer 1991, p. 482; Carsten 2000; Franklin and Ragone
1998). It can also be considered as a supplementary sign of the increas-
ing technocratization of society and beyond of the human body, by way of
which mind and body are considered as separated and body seen as a simple
machine (Davies-Floyd 1994, 2001; Oakley 1984). “As the factory produc-
tion of goods became a central organizing metaphor for social life, it also
became the dominant metaphor for birth: the hospital became the factory,
the mother’s body became the machine, and the baby became the product
of an industrial manufacturing process” (Davies-Floyd 2001, p. S6). Finally,
surrogacy reflects a world where increasingly everything can be outsourced,
including parenthood and motherhood.
Surrogacy has also become “a multibillion-dollar global capitalist enter-
prise in which patients’ interest may not always be paramount and where
the potential for the exploitation of donors and surrogates is ever present”
(Hudson et al. 2011, p. 579, Spar 2006). In Thailand, “The fertility sec-
tor - an important component of Thailand’s ‘medical tourism’ market -
attracts more than 2.5 million foreign patients and earns more than $ 4.5
TRANSNATIONAL SURROGACY 43
billion annually” (Alford 2014). In India, where there is estimated to be

1000 clinics practicing commercial surrogacy (3,000 according to Kumar
2015), annual earnings may reach $ 2.5 billion (Marriner 2012).
‘The baby business’ (Spar 2006) has organized services, and it is heavily
built on advertisement, especially sophisticated marketing on the Internet,
which fuels demand and competition between agencies. The presentation
of such services is often multilingual and highlights the transnational char-
acter of the offer and the accommodation facilities that go with it (Martin
2009). Therefore, commissioners can see themselves as consumers who
choose their fertility destination among various offers (Speir 2011) and
become global consumers, able to buy their way out of inconvenient or
onerous policies (Martin 2009). Sensible Surrogacy is an agency that first
operated in Thailand and India, and later in Mexico, and now Cambodia
and Ukraine have been added. It presents itself on its website (accessed in
January 2014) as “The only agency with complete and affordable service”
that makes “in vitro fertilization simple and affordable for loving couples
to create complete families. This includes the best prices for services avail-
able in the region, and the best care for you and your new family.” The sci-
entific argumentations and the prices are listed. When accessed in October
2014, the presentation on the website has changed and has become more
sophisticated. The rhetoric now highlights the ethical character: “Sensible
Surrogacy is an ethical IVF/surrogacy agency with client support in Europe
and North America”, probably to counter accusations of objectification and
in order to be more in tune with today’s preoccupations, emphasizes that
the agency does not function as a baby factory. Los Angeles-based Planet
Hospital started its surrogacy program with the ‘India bundle’ (Planet Hospital
2014)
, which included “an egg donor (often from the United States); four
embryo transfers into four separate surrogate mothers, room and board for
the surrogate, and a car and driver for the parents-to-be when they travel
to India to pick up the baby”. In early 2014, Planet Hospital closed and
then reopened offering kidney transplants, gastric bypass, tummy tucks,
and other surgery, but not surrogacy (Lewin 2014). Chrysalis Surrogacy
is a Thai ‘infertility center’. “We provide moral, emotional, ethical and
most advanced technical support to intended parents who are trying out
to find a solution to fulfill their dream of a family by surrogacy in Thailand.
We provide services to heterosexual and LGBT couples and individuals,
single men and women, all in accordance with the actual needs of each
intended parent.” The rhetoric is similar on the Akanksha Infertility Clinic
website which operates in Gujarat, India (Akhanksha Infertility Clinic):
“A state-of-the-art infertility center dedicated to successful outcomes. Our
44 F. NAHAVANDI
mission is to provide world-class care to our patients as well as extraor-

dinary care for the women who choose to become surrogates (…) We
are not in the business of ‘renting wombs,’ a term tossed around by the
media but which could not be further from reality.” Finally, Hiranandani
Hospital, operating in Mumbai, presents itself in the same way. “We at
our center have a different approach to a couple with sub fertility. It is an
individualized approach, understanding the root cause of infertility and
treating it appropriately with tailor made investigations and procedures”
(Hiranandani Hospital). Even in countries where surrogacy is forbidden, it
may be advertised as highlighted in the case of China. “In a small confer-
ence room overlooking this city’s smog-shrouded skyline, Huang Jinlai
outlines his offer to China’s childless elite: ‘a baby with your DNA, gender
of your choice, born by a coddled but captive rural woman’. The arrange-
ment is offered by Mr. Huang’s Baby Plan Medical Technology Company,
with branches in four Chinese cities” (Johnson et al. 2014).
Making the infertile fertile is one of the genuine advances of modern
biomedicine, however it does not benefit everyone equally and further-
more, brings about the legitimacy of advertising and an unregulated mar-
ket where vulnerable clients, yearning for a baby, can be preyed upon by
companies and brokers, and vulnerable women yearning for better life can
be instrumentalized. Last but not least, surrogacy, and especially transna-
tional surrogacy, highlights many issues including fundamental questions
about the health and the mental situation of the women involved, what
constitutes a family, who is considered a legal parent, who is eligible for
citizenship, the child’s best interests, whether paid childbirth is a service
or exploitation, and how nations should respond to it.
THE DEMAND
Commissioning surrogacy means seeking out a woman to initiate, ges-
tate and deliver a baby, usually in return for financial compensation. It is
grounded in a growing demand fueled by increasing information, adver-
tisement about infertility and possibilities to overcome it, the reality of
reproductive science, and the new way individuals see their place and role
in society as parents. In turn, transnational surrogacy is enabled by global-
ization, which allows the transnational travel of persons, technologies and
ideas (Appadurai 1996) commercialization of ARTs (Spar 2006), and the
flourishing of transnational agencies, which put would-be parents in touch
with potential surrogates. The latter can even take the form of a ‘buyer’s
market’ (Klein 2014) such as the one organized by Surrogacy Australia, in

May 2014. The event assembled surrogates and egg donors from Australia
and overseas, and local and international IVF clinics from Thailand, India
and Mexico. The patients’ choices often determine the success of brokers
and clinics (Speir 2011). At the present time, it seems that the United
Kingdom “has the highest number of people in Europe seeking surrogacy
overseas and the second-highest globally after Australia” (Head 2015a, b).
The Commissioners
Whilst commissioners share some characteristics, they also differ in signifi-
cant ways (Hudson et al. 2011). They are mobilized for reasons similar to
those of most ‘medical tourists’ such as affordability, queue jumping and
destination countries’ attraction policies (Pfeffer 2011, p. 638). However,
surrogacy demand is also grounded in other motivations. Hudson et al.
(2011) emphasize the importance of taking into account series, unself-
conscious collective unities (Young 1994), to avoid the danger of essen-
tializing what are the complex and often ambiguous motivations for travel
and therefore not simplifying and stereotyping the set of issues and con-
cerns which characterize the decision of commissioners who are trying to
overcome infertility. In Western countries, the latter is rarely perceived
as a political or public health issue (Becker and Nachtigall 1992), but
nevertheless, infertility can be a burden (Greil 1991, 1997; Inhorn 1994)
and may be seen as a stigma (Whiteford and Gonzalez 1995) as it can be
all over the world. For the commissioner, surrogacy may be motivated,
among others, by family formation for those who are ‘socially infertile’
(those who do not qualify for adoption) including older people, single
people and gay couples (Cuthbert and Fronek 2014). The nature and
reasons of travelling abroad may differ significantly depending on national
regulations, funding of IVF and ARTs treatments (Storrow 2005), short-
ages of gametes providers, costs and access to a cheaper or wider range
of services, bypassing regulations and laws in the home country, and
even the desire to combine treatment with holidays. Some commission-
ers even allude to the altruistic or humanitarian effects it can have or the
philanthropy in which they are helping a Global South’s family (Cuthbert
and Fronek 2014; Vora 2013). Genetic link considerations and language
accessibility or religion of the destination country can also be decisive
(Inhorn 2011). Inhorn (2011) has also presented the phenomenon of
‘return reproductive tourism’ a variant of transnational surrogacy, which
46 F. NAHAVANDI
she states has three distinctive features: a return to the country of origin to
undertake assisted reproduction technology; a holiday visit to family in the
home country; and motivation by a set of factors that are different than
those usually cited in scholarly literature including: for diaspora, perceived
cultural discrimination in the host country, familiar environment, parents’
support, greater trust in local medicine, phenotypic similarity, and linguis-
tic similarity or similar religious background of physicians. In their study
examining the United Kingdom patient trajectories, Hudson et al. (2011,
p. 577) acknowledge that commissioners “are often strongly (though not
unambiguously) characterized by a ‘consumerist’ ideology, in which they
see themselves as actively taking charge of their fertility journey, aided by
readily available information sources, and importantly, the knowledge that
many years in UK-based treatment had given them”. The same goes with
the Americans who “may be proactive in that they forge new do-it your-
self journeys with cross reproductive border care” (Speir 2011, p. 598).
Finally, the popularity of ARTs is affected by social and cultural attitudes
to any new innovations and interventions, and largely shaped by what is
considered the norm (Van Acker 2007).
The Desire for a Child

Notwithstanding, the desire for a child has to be scrutinized, as ARTs
may transform conceptions of kinship and motherhood or reify economic,
racial and sexual hierarchies. In the nineteenth century, being a single
mother was burden and public disapproval was strong (Zelizer 1994).
Baby farming, a practice of taking in unwanted babies, and, in return for
a commercial fee, either over-crowding them, or killing them, was not
unusual (Broder 1988). Zelizer (1988, p. 23), as do Cuthbert and Fronek
(2014), argues that understanding surrogacy’s choice requires framing the
issue in continuation of a history of a child, and of the appearance of adop-
tion. Particularly, following economically motivated adoption, the turn to
sentimental adoption created an unprecedented demand for very young
children and a new kind of baby market, where the value of a priceless
child became increasingly monetized and commercialized (Zelizer 1988,
p. 26). In that framing, surrogacy appears as only a technical innovation,
the latest stage of a very special adoption market, which began in the
1920s with the emergence of the economically worthless, but emotionally
priceless child (Zelizer 1988). Rotabi and Bromfield (2012) also highlight
the shift from adoption to surrogacy demand. Hence, “Today, surrogacy
arrangements introduce a new ‘custom-made’ market for children. Fees

are paid not just to obtain someone else’s baby, but also to produce a brand
new one.” Surrogacy is not just a sentimental search for any child to love,
but the deliberate manufacture of a particular suitable child. For example,
in 2014, an Australian couple, who paid a Thai surrogate to carry twins,
returned home with a baby girl, leaving behind her twin brother who had
Down syndrome. (Gecker 2014; Hookway 2014; Williams 2013; Maiden
2014). To some extent, surrogacy unequivocally reveals the discrimina-
tory valuation of children. Babies are made on ‘special-order’, because
children already available on the adoption market are not ‘good’ enough;
they are either too old, too sick or have the wrong skin color (Zelizer
1988, p. 28).
Furthermore, class makes a difference (Banerjee 2014). According to
Rothman (1988, p. 21–23), surrogacy is “the reduction ad absurdum of
Western patriarchal capitalism, an intersected issue of class, race deeply
rooted in essential patriarchal concepts and ideology governing reproduc-
tion. By surrogacy, women can be seen as owning their children, having
‘rights’ to them, just like men do based on their seed. In this instance, some
of the privileges of patriarchy are extended to upper-class women: rich
women can hire women to grow their seed for them. Women with money
and power can exercise their rights of ‘paternity’ declaring ownership of
baby grown of their seed in another woman’s body, in a rented uterus”.
This goes beyond sex and class, and deals with the issue of race as well, as a
uterus needs not to be the same race as the fetus she bears. Usually, it is the
woman of color who rents her womb (Rothman 1988, p. 22). However,
the race factor has also been illustrated in China where tradition holds
that couples must have a child but where “upper-class clientele would not
accept a foreign woman they regard as inferior as a surrogate, even though
the cost is lower. Chinese don’t want their children carried by people who
are more backward than they are” (Johnson et al. 2014).
Surrogacy may be a long and costly process, however it illustrates that
beyond the desire of a child, many factors intervene such as race, class,
and sex, which become entwined in their functioning and their ideology.
Moreover, as surrogacy is spreading, it involves many stakeholders: prob-
ably Health Ministries, the hospitals, the immigration services, doctors
and surrogacy agents… The baby industry is becoming so lucrative that it
can give way to usurpers presenting themselves as doctors and practicing
without proper licenses.
48 F. NAHAVANDI
THE SUPPLY
Although a fairly recent phenomenon in a rapidly globalizing world,
besides some United States and European destinations where surrogacy
is allowed, women and couples are increasingly traveling, especially to
high-tech low-cost countries. India and Thailand are usually favored, as
they combine high-tech infrastructure and qualified doctors together with
pockets of poverty, which encourage women to rent out their wombs to
wealthy foreigners or wealthy locals. However the number of supplying
countries in the Global South is growing. The destination countries illus-
trate that surrogacy is embedded in racial and class hierarchies and has
become a form of stratified reproduction in which poor women deliver
a child for wealthier women and men. As a consequence of growing
demand, many women have found their way into the global market, trans-
acting their body and their reproductive labor. They sell their body as part
of the global-transnational networks of technology, medical services and
trade in organs. Indeed, for many women surrogacy is turning into a kind
of profession—albeit often as invisible labor—with its own vocabulary:
some surrogates now prefer to be known as ‘gestational carriers’ working
in ‘baby factories’.
India, the Most Studied Destination

Although transnational surrogacy is a growing industry, highly beneficial
for some states and private enterprises in the Global South, there are few
in depth studies addressing gestational carriers. The most studied coun-
try is India (Pande 2009a, b, 2010a, b, 2011; Vora 2009a, b; Majumdar
2014a, b) where an examination of gestational carriers will probably first
highlight that women are subject to practices (risks, no parental rights, less
compensation) that would not be tolerated in many Western countries.
Poverty is the main factor underlying the offer of surrogacy in the Global
South (Majumdar 2014a). The offer often comes either from rural areas
characterized by growing poverty and inequalities or from disadvantaged
economic regions. Among others, Vora (2009a, b) highlights that many
gestational carriers are day laborers from rural communities. Karandikar
et al.’s (2014) research in Gujarat confirms the low socioeconomic back-
grounds, while they also refer to the very clear financial motivation of
gestational careers. In India, most of the cases studied by scholars pro-
vide evidence of family income below or around the poverty line. Usually,
women with few prospects for either themselves or their husbands, sign
up to carry a baby for another couple. Neverteless, in some cases, nurses
and teachers or women working in farms and stores (Pande 2009b) also
become surrogates, for example, when their husbands lose their jobs. In
Pande’s research, all surrogates are married with children; however, some
may be divorced or have left their abusive husband (Deomampo 2013).
For most of the surrogates’ families, the money earned through surrogacy
is equivalent to nearly 10 years of family income especially since many of
them have husbands who either are in informal contract work or unem-
ployed (Pande 2009b, p. 383). Thus, the typical supplier is economically
vulnerable.
In terms of surrogate women’s education, the average is around the
beginning of middle school (Pande 2009b). Vora’s study (2009a) refers
to middle school, or a high-school equivalent education. In that frame,
the transparency of surrogacy contracts can be questioned when they are
in English, a language that gestational carriers likely cannot read, or when
they are illiterate and not able to read or understand it. Furthermore, a
2013 study conducted by the nonprofit Centre for Social Research high-
lighted that 88 percent of gestational carriers interviewed in Delhi and 76
percent in Mumbai did not know the terms of their contract. In fact, 92
percent of those in Delhi did not even have a copy of it. Thus, those who
employ, broker and organize these women’s services have advantages over
them in resources and information, an asymmetry, which exposes them to
exploitation and abuse (Damelio and Sorensen 2008).
Hope underlies the women’s decisions: easing family burden, sending
children to school, even providing funds or dowries for marriage. The
motivations behind accepting the contract hide the financial motivations,
and, as presented by women, are often altruistic in nature and in rela-
tion to children and family: the need to educate children, the well being
of family, the children’s welfare… The vocabulary used by surrogates in
India ‘majbouri’ (Pande 2009a; Majumdar 2014b; Karandikar et al. 2014;
Rotabi and Bromfield 2012), a local word referring to vulnerability, pow-
erlessness and helplessness (Grover 2011, p. 75) gives a good illustra-
tion of the overall situation. The husband may agree and encourage the
decision or even force the woman to accept surrogacy or search for it.
Sometimes he does not agree and has to be convinced.
As globalization and factory work have made the Global South’s
women workers feel disposable, and this is an integral part of the work-
ing of global capitalism (Chang 2000; Ehrenreich and Hochschild 2003),
50 F. NAHAVANDI
commercial gestational surrogacy in India, in general, and the rules of

the clinic, in particular, reiterate the disposability of the women (Pande
2009a). Housing has become a common practice in surrogacy arrange-
ments. It permits surveillance. The gestational carriers are increasingly
kept in hostels (baby factories) that are run by IVF clinics and/or agents
(Carney 2011; Pande 2009a; Vora 2009a, b) where, during their preg-
nancy, “their food, medicine, daily activities can be monitored by the doc-
tor or employees” (Pande 2009b, p. 382). In these baby factories, women
have to follow strict rules and codes of nutrition and behavior. They may
be unable to move out or see their family. They are forced to rest. They
are trapped in an unfamiliar way of life, especially compared to their previ-
ous pregnancies. Usually when living in hostels, family and husband visits
are highly regulated, and if allowed to visit, they cannot stay overnight.
The surrogacy contracts prohibit women from having sexual relations and
those who live in hostels are under additional surveillance. Daily life is
repetitive. Women have nothing to do except walk around, talk together
and wait for injections or other monitoring (Pande 2009b, p. 382).
However, in some cases the hostel can also become a ‘community’ where
ties with other surrogates can even serve as a powerful tool against brokers
or as resources and networks for future employment and where a sense of
collective identity may grow (Pande 2009b, p. 390–91). Living in a hostel
can also be a way of hiding and protecting from a stigmatizing community
(Karandikar et al. 2014). Many surrogates do not tell their parents or in-
laws for fear of being ostracized. The parents may feel that the pregnancy
is inappropriate and cannot share in the experience. They may see it as a
‘sin’ (Majumdar 2014a, p. 211).
For the gestational carriers, the meaning of pregnancy can be called
into question (Majumdar 2014a). The pregnancy can become “the locus
of a ‘risky relationship’ ticking away like a bomb. Here the idea of risk
underlies the relationship between two sets of people who come together
to make a child” (Majumdar 2014a, p. 200). Surrogacy reflects a form
of disembodiment resulting in perceptions of risk that come to embody
the uncomfortably intimate relationships within the surrogacy arrange-
ment (Majumdar 2014a). “To feel ‘disembodied’ is both an affectual and
physical state within the surrogacy arrangement. It marks the relationships
negatively, creating conflicts and ambiguity and superimposes the tech-
nology and the medical personnel operating it as supreme” (Majumdar
2014a, p. 219). Usually, as is the case in India, there are minimal interac-
tions between the gestational carrier and the intended parents. The clinics
and the agents limit contact if they can, or completely monitor it (Vora
2009a, p. 9). Cultural and class-based distance between the two stake-
holders remains high. Pande (2011) argues that, in contrast to ethno-
graphic works in other parts of the world, revealing women involved in
surrogacy downplay the contractual relationship with each other, in India
narratives highlight and often reify the inequalities based on class, race and
nationality between the clients and suppliers of reproductive tourism. Vora
(2009a, p. 9) notes that women are trained to see themselves as gestation
providers whose only link to the fetus is the renting of a womb imagined
as an otherwise empty and unproductive space. However, Pande (2009b)
speaks of how surrogates try to establish a link with the fetus through their
role of nurturance, even when they are not connected to it genetically.
The women build their own sense of kinship with the unborn child during
the pregnancy.
In the surrogacy process, discourse has a main place. Doctors empha-
size disembodiment and gestational carriers emphasize contradictory feel-
ings of disembodiment and embodiment…Women interviewed by Pande
(2009b) who uses the concept of “everyday forms of kinship”, develop
a discourse based on kinship ties as the product of conscious everyday
strategy, and at times, as a vehicle for survival and/or resistance. Their
discourse focuses on blood ties and labor, as the main basis for making
kinship claims. The latter can be interpreted as not only challenging patri-
lineality, but also allowing the women to reiterate their primary role in the
surrogacy process and consequently, laying some claims over the money
earned through surrogacy (Pande 2009b, p. 386). The creation of a sense
of ownership that focuses on kinship and labor of gestation over genes is
an inversion of the American surrogate’s strategy of dissociation wherein
the nurturance of the adoptive mother is privileged over the pregnancy
(Majumdar 2014b, p. 293). Pande (2010a, p. 5), following James Scott
(1985), illustrates how women create a discourse about surrogacy that
remediates the stigma attached to it, and how they simultaneously resist
the subordinate position to which they are usually assigned in dominant
discourses. Stigma and dissonance are avoided by framing surrogacy in the
rhetoric of gift, divine intervention, being special or being dutiful moth-
ers, rather than wage-earning workers. Notwithstanding, surrogacy is
another form of labor, a new form of informal, gendered and stigmatized
work; even though the language of stigma suppresses the development of
a worker’s identity (Pande 2009a, b).
52 F. NAHAVANDI
The ongoing usual framing of surrogacy conceals “the reality of a devel-

oping country setting-where commercial surrogacy has become a survival
strategy and a temporary occupation for some poor women, where women
are recruited systematically by a fertility clinic and matched with clients
from India and abroad” (Pande 2009a, p. 144). While they are nurturing
someone else’s baby in exchange for money, which can be compared to the
historically reproductive labor of preparing food, laundering, repairing,
providing care—work that poor women have always done—surrogacy has
a sexual stigma attached to it. According to Majumdar (2014b, p. 289)
the “ideology of the gift relationship is the bedrock of the commercial
surrogacy arrangement creating a façade of altruism when, in reality, there
is none. The preponderance of such an ideology is meant to imbue the
arrangement with some level of sanctity and legitimacy considering its
positioning in relation to commoditization of intimate relationships. The
rhetoric of the ‘gift’ within the surrogacy arrangement is the source of an
unequal relationship. Thus the structural conditions and make-up of the
arrangement position the surrogate as a ‘giver’ within a hierarchical and
obligatory relationship.” In turn, Pande (2011) notes that if in the Global
North surrogates have tendencies to present themselves and be presented
as ‘angels’ and ‘heroines’, in India, the discourse of gift is less present and
women do not see themselves as gift-givers. The paradox is they often
present surrogacy as ‘the gift of god’, and as ‘god’s gift to needy but not
greedy women’. Alongside, the Global North angelic gift-giver is con-
verted to a needy gift receiver in the Global South.
Considered broadly, the gestational carriers’ narratives position their
reproductive choice in the framework of family coercion and agency.
Surrogacy can be a strategy for women to respond to the structural and
social constraint they meet daily. Deomampo (2013, p. 168) highlights
the need to avoid reductions to simplistic stereotypes and binary opposi-
tions between agent and victim, rich and poor, North and South. Her
study denotes a stratification of reproduction. At the same time that they
are considered as weak and vulnerable, women also construct forms of
resistance and individual and collective agency to challenge everyday gen-
der norms and create new opportunities for themselves and their families
within an arrangement that seems overwhelmingly debilitating. Whatever
it might be, Hochschild (2011) argues that Indian surrogates are suffering
from alienation as an extension of their outsourced self in the transnational
trade of the reproductive health of women from the Global South. In
turn, the study of New Delhi’s Centre for Social Research (2013) draws
on the emotional burden of gestational carriers that would feel attached to

the babies even though they were not biologically their own children. The
study highlights the relinquishing of the child as the most difficult part
in the whole surrogacy arrangement. In most of the cases, the decision
regarding the handing over of the surrogate baby is made by the commis-
sioning parents.
In order to regulate the growing practice and industry of surrogacy, the
Indian government has introduced regulations that apply to couples seek-
ing to enter into a surrogacy arrangement. Specifically, it requires that par-
ents who seek a surrogate be man and woman duly married and that the
marriage be sustained at least two years. Therefore gay foreign couples are
banned from hiring surrogate mothers. However, no regulation applied to
surrogates has yet been endorsed.
Other Destinations
Even though Indian surrogates have been the most studied recently, Thai
gestational carriers also garnered attention before surrogacy arrangements
with foreigners became illegal. At its peak, Thailand was a favored desti-
nation for many Westerners seeking surrogate mothers, so much so that
the country was nicknamed ‘the Womb of Asia’ (Head 2015). Indeed,
whereas, in the United States for example, surrogacy can cost upward of
$100,000, in Thailand, surrogacy costs were closer to $40,000 (Philip
2015). In addition to individual cases, surrogacy became a group strategy.
Some poor rural villages were even transformed to what has been labeled
“baby farms”. Among them was Pak Ok, where gestating became lucrative
after one woman’s situation improved noticeably after giving birth as a
surrogate (Fuller 2014). Commercial surrogacy was not technically illegal
in Thailand. However, in 2015, a law banning foreigners from paying
Thai women to be surrogates was passed. The legislation now bans com-
mercial surrogacy, the use of agents or any promotion of women willing
to carry babies for others. Under the new law, only married Thai couples
or couples with one Thai partner who have been married at least three
years can seek surrogacy. Anyone caught hiring a surrogate mother faces a
maximum jail sentence of 10 years (Head 2015a, b). Nevertheless, it can
be feared that it will remain tempting for poor families to contravene the
law and that the business will survive underground. Moreover, since the
ban, some agencies have focused on expanding their services in Nepal and
potentially Cambodia. The latter has no laws on surrogacy. Nepal recently
54 F. NAHAVANDI
allowed surrogacy services for foreigners. Nepali women are not allowed
to be surrogates. In consequence, Indian women have been crossing into
Nepal for that purpose (Drennan 2015).
Even though North to South has mostly characterized transnational sur-
rogacy flows, nowadays a South/South circulation has also been installed.
It is apparent in cross-border surrogacy between China and Vietnam, or
between China and Thailand. Chinese law forbids surrogacy, according to
a 2001 regulation on assisted reproductive technology. At present, regula-
tion also prohibits the trading of any human gamete, zygote or embryo.
However, some agencies send poor women to Bangkok for embryo implan-
tation, then fly them back to China, where they live hidden lives during
the pregnancy and birth (Johnson et al. 2014). The illegal surrogacy black
market continues to thrive in China (Hairong 2012; Gan 2014).
To conclude this chapter, it can be said that even though surrogacy is
one of the genuine advances in modern biomedicine, it has been trans-
formed into big business. In this process, wealthier women and men from
the Global North use a new resource from the Global South’s women.
When regulation becomes too complicated in one country, the demand
flies to a neighboring one, where it does not yet exist. Thus, the commod-
ification of the womb preys on the reproductive capacity of some women
by turning them into objects of consumption. The process illustrates a
reality by which female and increasingly male consumers use the womb
of strangers to fill in a perceived bodily shortcoming. Moreover, surro-
gacy highlights the process by which the citizen-consumers of the global
market depend on the definition and disciplining of producers-workers on
whose backs the citizen-consumer gains legitimacy. In turn, the transna-
tional surrogacy can also been considered as a business in body parts that
contributes to the global capitalism’s objectification of the Global South’s
women and their labor, and a world where increasingly everything can be
outsourced including conception, pregnancy and birth.
REFERENCES
Alford, P. (2014, August 11). Surrogacy scandal spurs Thai probe into baby traf-
ficking. The Australian. Retrieved January 5, 2015, from http://www.theaus-
tralian.com.au/news/world/surrogacy-scandal-spurs-thai-probe-into-baby-
trafficking/story-e6frg6so-1227019715555?nk=cba12d0ce6364125e91d51d
171b1899a
Anderson, E.S. (1990) Is women’s labor a commodity. Philosophy and Public
Affairs, 19, 71–92.
Andrews, L.B. (1987). The aftermath of Baby M: proposed laws on surrogate

motherhood. The Hastings Center Report, 17(5), 31–40.
Appadurai, A. (1996). Modernity at large: Cultural dimensions of globalization.
Minnesota: University of Minnesota Press.
Banerjee, A. (2014). Race and a transnational reproductive caste system: Indian
transnational surrogacy. Hypatia. 29(1), 113–128.
Becker, G., & Nachtigall, R. D. (1992). Eager for medicalisation: The social pro-
duction of infertility as a disease. Sociology of Health and Illness, 14(4),
456–471.
Broder, S. (1988). Child care or child neglect? Baby farming in late-nineteenth-
century Philadelphia. Gender and Society, 2(2), 128–148.
Carsten, J. (Ed.). (2000). Cultures of relatedness: New approaches to the study of
kinship. Cambridge: Cambridge University Press.
Centre for Social Research. (2013). Surrogate motherhood, ethical or commercial,
New Delhi. Retrieved July 20, 2015, from http://www.womenleadership.in/
Csr/SurrogacyReport.pdf
Chang, G. (2000). Disposable domestics: Immigrant women workers in the global
factory. Cambridge: South End Press.
Collen, S. (1995). ‘Like a mother to them’: Stratified reproduction and West
Indian childcare workers and employers in New York. In R. Rapp & F. Ginsburg
(Eds.), Conceiving the new world order: The global politics of reproduction
(pp. 78–102). Berkeley: University of California Press.
Cuthbert, D., & Fronek, P. (2014). Perfecting adoption? Reflections on the rise of
commercial offshore surrogacy and family formation in Australia. In A. Hayes
(Ed.), Families, policy and the law (pp. 55–66). Melbourne: Australian Institute
of Family Studies.
Damelio, J., & Sorensen, K. (2008). Enhancing autonomy in paid surrogacy.
Bioethics, 22(5), 269–277.
Davies-Floyd, R. (1994). The technocratic body: American childbirth as cultural
expression. Social Science and Medicine, 38(8), 1125–1140.
Davies-Floyd, R. (2001). The technocratic, humanistic and holistic paradigms of
childbirth. International Journal of Gynaecology & Obstetrics, 75(Suppl. 1),
S5–S23.
Deomampo, D. (2013). Transnational surrogacy in India. Frontiers, 34(3),
167–188.
Drennan, J. (2015, March 2). The future of womb for rent. FP. Retrieved July 22,
2015, from http://foreignpolicy.com/2015/03/02/the-future-of-wombs-
for-rent/
Ehrenreich, B., & Hochschild, A. (Eds.). (2003). Global women: Nannies, maids
and sex workers in the new economy. New York: Metropolitan Books.
Franklin, S., & Ragone, H. (1998). Reproducing reproduction: Kinship, power and
technological innovations. Philadelphia: University of Pennsylvania Press.
56 F. NAHAVANDI
Fuller, Th. (2014, August 26). Thailand business in paid surrogates may be foun-
dering in moral quagmire. The New York Times.
Gan, N. (2014, September 23). ‘You can even tailor your baby sex’: Inside an illicit
Beijing surrogacy firm. South China Morning Post. Retrieved October 18,
2014, from http://www.geneticsandsociety.org/article.php?id=8086
Gecker, J. (2014). News guide: Thailand’s surrogacy scandals and law. AP. Retrieved
January 16, 2015, from http://bigstory.ap.org/article/news-guide-thailands-
surrogacy-scandals-and-laws
Greil, A. L. (1991). Not yet pregnant: Infertile couples in contemporary America.
New Brunswick: Rutgers University Press.
Greil, A. L. (1997). Infertility and psychological distress: A critical review of the
literature. Social Science and Medicine, 45, 1679–1704.
Grover, S. (2011). Purani aur nai shaadi: Separation, divorce, and remarriage in
the lives of the urban poor in New Delhi. Asian Journal of Women’s Studies,
17(1), 67–99.
Hairong, W. (2012, February 27). Surrogacy under scrutiny. Beijing Review.
Retrieved October 18, 2014, from http://www.geneticsandsociety.org/arti-
cle.php?id=6093
Head, J. (2015a, February 20). Thailand bans surrogacy for foreigners. BBC News
Asia. Retrieved July 22, 2015, from http://www.bbc.com/news/
world-asia-31546717
Head, J. (2015b, August 15). Thailand stops couples leaving with surrogate
babies. BBC News Asia. Retrieved July 22, 2015, from http://www.bbc.com/
news/world-asia-28811779
Hochschild, A. (2011). Emotional life on the market frontier. Annual Review of
Sociology, 37, 21–33.
Hookway, J. (2014, August 27). Thailand targets surrogacy practices Amid
Scandals. The Wall Street Journal. Retrieved January 16, 2015, from http://
online.wsj.com/articles/thailand-targets-surrogacy-practices-1409146050
Hudson, N., et al. (2011). Cross-border reproductive care: A review of the litera-
ture. Reproductive Biomedicine Online, 23, 673–685.
Inhorn, M. C. (1994). Quest for conception: Gender, infertility, and Egyptian medi-
cal traditions. Philadelphia: University of Philadelphia Press.
Inhorn, M. C. (2011). Diasporic dreaming: Return reproductive tourism to the
Middle East. Reproductive Biomedicine Online, 23, 582–591.
Johnson, I., Li, C., & Zhao, K. (2014, August 2). China experiences a booming
underground market in surrogate motherhood. New York Times. Retrieved
January 15, 2015, from http://www.nytimes.com/2014/08/03/world/
asia/china-experiences-a-booming-black-market-in-child-surrogacy.html
Karandikar, S., et al. (2014). Economic necessity or noble cause? A qualitative
study exploring motivations for gestational surrogacy in Gujarat, India. Affilia,
29(2), 224–236.
Klein, R. (2014, August 20). Baby Gammy has shown the need for debate on sur-
rogacy. The Age Comment. Retrieved January 16, 2015, from http://www.
theage.com.au/comment/baby-gammy-has-shown-the-need-for-debate-on-
surrogacy-20140819-105pfx.html
Kumar, R. (2015, January 14). Trying to tame the wild west of surrogacy in India.
Aljazeera America. Retrieved July 20, 2015, from http://america.aljazeera.
com/articles/2015/1/14/the-wild-west-ofsurrogacy.html
Lewin, T. (2014, July 27). A surrogacy agency that delivered heartache. New York
Times. Retrieved December 5, 2014, from http://www.nytimes.
com/2014/07/28/us/surrogacy-agency-planet-hospital-delivered-
heartache.html
Maiden, S. (2014, October 12). ‘Baby for visa deals’ feared in new cash for sur-
rogacy scandals in India. Daily Telegraph. Retrieved January 16, 2015, from
http://www.dailytelegraph.com.au/news/nsw/baby-for-visa-deals-feared-in-
new-cash-for-surrogacy-scandal-in-india/story-fni0cx12-1227087543805
Majumdar, A. (2014a). Nurturing an alien pregnancy: Surrogate mothers,
intended parents and disempowered relationship. Indian Journal of Gender
Studies, 21(2), 199–224.
Majumdar, A. (2014b). The rhetoric of choice: The feminist debates on reproduc-
tive choice in the commercial surrogacy arrangement in India. Gender Technology
and Development, 18(2), 275–301.
Marriner, C. (2012). Booming surrogacy demand sparks exploitation fears. The
Sydney Morning Herald. September 2. Retreived September 12, 2014 from
http://www.smh.com.au/national/booming-surrogacy-demand-sparks-exploitation-
fears-20120901-25742htlm
Martin, L. J. (2009). Reproductive tourism in the age of globalization.
Globalizations, 6(2), 249–263.
Nayak, P. (2014). The three Ms of commercial surrogacy in India: Mother, money,
and medical market. In S. Dasgupta & S. Dasgupta (Eds.), Globalization and
transnational surrogacy in India: Outsourcing life. Maryland: Lexington Books.
Oakley, A. (1984). The captured womb: A history of the medical care of pregnant
women. New York and Oxford: Basil Blackwell.
Pande, A. (2009a). Not an ‘angel’, not a ‘whore’: Surrogates as ‘dirty’ workers in
India. Indian Journal of Gender Studies, 16(4), 141–173.
Pande, A. (2009b). It may be her eggs, but it’s my blood: Surrogates and everyday
forms of kinship in India. Qualitative Sociology, 32(4), 379–397.
Pande, A. (2010a). At least I am not sleeping with anyone: The stigma of com-
mercial surrogacy. Indian Feminist Studies, 36, 292–314.
Pande, A. (2010b). Commercial surrogacy in India: Manufacturing a perfect
mother-worker. Signs, 35(4), 969–992.
Pande, A. (2011). Transnational commercial surrogacy in India, gifts for global
sisters? Reproductive BioMedicine Online, 23, 618–625.
58 F. NAHAVANDI

Online, 23(5), 634–641.
Philip, A. (2015, February 20). A shocking scandal led Thailand to ban surrogacy
for rent. Washington Post. Retrieved July 22, 2015, from https://www.wash-
ingtonpost.com/blogs/worldviews/wp/2015/02/20/a-shocking-scandal-led-
thailand-to-ban-commercial-surrogacy-for-hire/
Planet Hospital. Retreived January 3, 2014 and April 17, 2016, from http://
www.planethospital.com
Rotabi, K. S., & Broomfield, N. F. (2012). The decline of inter-country adoptions
and new practices of global surrogacy: Global exploitation and human rights
concerns. Affilia, 27, 129–141.
Rothman, B. (1988, March/April). Cheap labor, sex, class, race, and ‘surrocacy’.
Society, 21–23.
Scott, J. C. (1985). Weapons of the weak: Everyday forms of peasant resistance. New
Haven: Yale University Press.
Spar, D. (2006). The baby business: How money, science, and politics drove the com-
merce of conception. Boston: Harvard Business School Press.
Speir, A. R. (2011). Brokers, consumers and the Internet: How North American
consumers navigate their infertility journeys. Reproductive Biomedicine Online,
23, 592–599.
Van Acker, O. (2007). Psychosocial aspects of surrogate motherhood. Human
Reproduction Update, 13(1), 53–62.
Vora, K. (2009a). Indian transnational surrogacy and the disaggregation of moth-
ering work. Anthropology News, 50(2), 9–12.
Vora, K. (2009b). Indian transnational surrogacy and the commodification of vital
energy. Subjectivity, 28(1), 266–278.
Vora, K. (2013). Potential, risk and return in transnational Indian gestational sur-
rogacy. Current Anthropology, 54(7), S97–S106.
Whiteford, L. M., & Gonzalez, L. (1995). Stigma: The hidden burden of infertil-
ity. Social Science Medicine, 40(1), 27–36.
Williams, H. (2013, April 11). Are Indian surrogacy programs exploiting impov-
erished women? CBS News. Retrieved January 16, 2015, from http://www.
cbsnews.com/news/are-indian-surrogacy-programs-exploiting-impoverished-
women/
Wolifer, L. (1991). The influence of technology on the politics of motherhood.
Women’s Studies International Forum, 14(5), 479–490.
Young, M. (1994). Gender as seriality: Thinking about women as a social collec-
tive. Signs, 19(3), 713–738.
Zelizer, V. (1988, March/April 23–28). From baby farms to Baby M. Society.
Zelizer, V. (1994). Pricing the priceless child: The changing social value of children.
Princeton: Princeton University Press.
CHAPTER 5
Transnational Kidney Transplant
Abstract Chapter 5 focuses on kidney transplantation, by far the most

frequent type of transplant globally. Even though almost all countries ban
commercial transplantation, making it illegal to buy or sell organs, this life-
saving technology, through organ trafficking, has been transformed into big
business. Nahavandi argues that the latter reflects the reality of the extrac-
tion of a new resource from the Global South, and a world where increas-
ingly everything can be bought. People with the money to pay for a new life
use a new resource from the poor’s body. Kidney trafficking tells the story
of poverty and despair, and illustrates the inequities behind the transactions.
In this chapter, the motivations of the sellers together with the situation in
some of the key countries where trafficking exists are offered.
Keywords Pakistan • Bangladesh • Philippines • India • Medical tourism

• Kidney transplant • Kidney traffic • Poverty
THE KIDNEY AS A COMMODITY

The idea of replacing damaged or failed body parts has been around for
millennia, but most progress has been made over the course of the last
century, as organ transplantation has overcome major technical limita-
tions, thanks to an improved understanding of transplant rejection and the
use of immunosuppressive drugs, to become the success it is today (Baker

DOI 10.1057/978-1-137-50584-2_5
60 F. NAHAVANDI
and Markmann 2013; Watson and Dark 2012, p. i 30). Nevertheless, the
challenge to overcome the shortage of suitable donor organs has remained
from the outset. In the process, many organs are sold, including parts
of livers, and in an emergent field, corneas from the living. This chapter
focuses on kidney transplantation, by far the most frequently carried out
transplantation globally. Moreover, researchers have performed serious
field studies and surveys in the Global South, which therefore can be relied
on to best illustrate the reality of the extraction of resources from the
Global South’s poor. Nevertheless, from 2008 onward, as a result of finan-
cial crisis in Western countries, cases of impoverished people trying to sell
their kidneys, bone marrow, lungs or corneas, spurred on by the Internet
have also been reported (Yee 2012). Even though almost all countries ban
commercial transplant, making it illegal to buy or sell organs, it has neither
prevented the illegal trade, nor prevented new entrants from taking advan-
tage of the impoverished and vulnerable populations to provide kidneys
for desperate wealthy people in need of transplantation.
A kidney transplant is the replacement of a failed kidney with a healthy
one obtained either from a living relative, an unrelated living donor, or a
recently deceased person. From the first unsuccessful attempt in 1906 to
transplant a goat and a pig kidney into two patients, through the first use
of a human kidney in 1936 and the first truly successful kidney transplant
from one twin to another in 1954, to today’s practices, organ transplanta-
tion has overcome major technical limitations. The introduction of the
immunosuppressant drug cyclosporine in 1983 revolutionized transplan-
tation by substantially improving kidney transplant results as it greatly
facilitated successful extra-renal transplants. Among others, it increased
the potential donor pool for any given patient. Nowadays, as the number
of patients on the waiting lists is progressively increasing, so does the num-
ber of living donors, such that there are more living donors than deceased
ones, as has previously been the case.
Consequently and progressively, kidney transplant has become an inte-
gral part of a growing transnational health travel, usually called ‘medical
tourism’, which may seem tempting for people without insurance and in
some cases—as in the United States—is even encouraged by insurance
companies, which have started to send patients abroad and give them
discounts if they accept it. Furthermore, kidney transplantation also
“describes a social and medical reality that is being actively promoted by
governments and by private companies in parts of the so-called developing
world” (Scheper-Hughes and Roberts 2011, p. 4). Nevertheless, “com-
pared to medical tourism, the paradigm in transplant tourism is different,
TRANSNATIONAL KIDNEY TRANSPLANT 61
because there is another party involved. In transplant tourism a person

as an organ vendor provides his/her organ through an arranged transac-
tion by a middleman, a practice that is illegal in almost all countries in the
world. In transplant tourism not just the patient, as recipient, travels for
transplantation, there is another person, an organ provider, who may or
whose organ may also travel for transplantation” (Bagheri 2010, p. 297).
Hence, kidney transplant is now globalized: A living provider can travel to
sell an organ; a recipient can fly to another country to purchase an organ;
and finally, both recipients and sellers from different countries can move to
a third country. Moniruzzaman (2012) argues that in Bangladesh, almost
all of buyers are Bangladeshi-born foreign nationals who purchase organs
within Bangladesh and then obtain their transplant surgery in India,
Bangladesh, Thailand or elsewhere.
According to the World Health Organization (WHO), 10 percent of
transplantation around the world annually involves payment to non-related
donors (Garwood 2007, p. 5), while selling has become an “inevitable
activity masked by the rhetoric of saving lives” (Moniruzzaman 2012,
p. 84). In any case, at present, kidney transplantation has “outpaced the
implementation of internationally accepted ethical standards for procur-
ing transplantation organs” (Mendoza 2010, p. 255). As a matter of fact,
the success of transplant technology, alongside the commercialization of
health care and the increasing polarization between rich and poor, have
also created conditions for an illegal trade in human organs that includes
many actors, like states, media, health specialists, brokers, organ recipients
and sellers (Moniruzzaman 2012, p. 71). The trafficking has prompted
the WHO to suggest that humanity is being undermined by the vast prof-
its involved and the division between poor people who undergo ‘amputa-
tion’ for cash and the wealthy sick who sustain the body parts trade. In
turn, Cohen (2001, p. 25) highlights the “animal existence of the poor
transformed into an organ bank for the better off” and comments that
as the recourse to cyclosporine has globalized, “myriad biopolitical fields
have been created, where donor populations are differentially and flexibly
materialized. Difference is selectively suppressed, allowing specific sub-
populations to become ‘same enough’ for their members to be surgically
disaggregated and their parts reincorporated” (Cohen 2001, p. 11–12).
The WHO’s Guiding Principles on Human Organ Transplantation
(1991) already stated that the commercialization of human organs is “a
violation of human rights and human dignity”. Nevertheless, it is going
on, and the fact is that nowadays, the poor body’s kidney is increasingly
being used. Even though organ transplantation is a life-saving technology,
62 F. NAHAVANDI
organ trafficking is supplying organs to people with the money to pay for
a new life. In the same manner that surrogacy has outpaced adoption,
the kidney market has allowed families not to risk their own people and
instead turn to poor people from the Global South. Today, organ trans-
plants in general, including kidney, give rise to many questions about the
way in which the medical scientific community and biotechnology indus-
try treat persons and their bodies, human life, dignity (Mousourakis 2010;
Wilkinson 2012, 2008; Sharp 2007) and poverty. Moreover, kidney trans-
plant is another example of the separation of body and mind in a techno-
cratic society. The multidisciplinary field of bioethics emerged partly in
response to these developments. Finally, “As kidneys are treated like any
other commodity in the market, the question is how far these body parts
are one’s individual property and a responsibility of the society” (Rocafort
Gatarin 2014, p. 119).
In that environment, organ trafficking has become big business. It is
a transnational trade that is happening in many places throughout the
world. As opposed to human trafficking or drug trafficking that is con-
trolled by shady brokers, physicians in countries like India, Pakistan and
the Philippines use their contacts, and work with middlemen in shanty-
towns and slums of large cities in developing countries to control body
trafficking. Globalization and medical progress sustain the organ market
in the Global South, especially in Asia where patients who are waiting for
an organ and can afford it are increasing. Manzano et al. (2014) argue that
the complex factors that perpetuate invisibility facilitate trafficked organs
being laundered in the health care systems of the purchaser’s country, hin-
dering accurate estimation of the problem. Among others, they factor the
power of health care professionals and the reimbursement of transplanta-
tion costs abroad by insurers.
THE DEMAND
Kidney disease is estimated to affect 10 percent of the population world-
wide, and with more people developing hypertension and diabetes, that
percentage will likely increase (Mendoza 2010). Furthermore, the num-
ber of patients diagnosed with end-stage renal disease is also growing.
Over the last years, kidney transplants between related individuals have
diminished. Even though kidneys can also be obtained from cadavers, this
is not always the case as they may be buried without having their parts
harvested for many reasons ranging from lack of authorization to cultural
and religious taboos. Therefore, kidney transplants from living donors or

sellers are becoming increasingly preferable. One of the main arguments
underlying the demand for living kidney donors is scarcity and hence the
issue of availability. When they exist, the donation programs cannot keep
with the demand. Worldwide, many patients are waiting to receive an
organ and the number is increasing. The waiting lists may not reflect real-
ity, as they may refer only the best candidates for transplant. Meanwhile,
medical travel follows and is produced by what biomedical technologies
promise to provide at the destination (Scheper-Hughes and Roberts
2011). Moreover, this type of demand is fuelled by national regulations,
legal requirements, health care system and reimbursements for transplants
travel, cheaper costs abroad, the infrastructure of the destination coun-
try and its promoting and advertising policies, mainly by the Internet,
which is expanding. In 2006, in the Philippines, the Philippine Medical
Tourism Inc. promoted on its website: ‘A kidney transplant operation in
Davao and Cebu is offered at $ 60,000 whereas the procedure could cost
$140,000 in other countries’ (Yea 2010, p. 361). In Bangladesh, organ
selling is “tacitly endorsed by national media that openly publish newspa-
per classifieds seeking kidneys, livers, corneas, and any other transplantable
part of the human body” (Moniruzzaman 2012, p. 70). In India, “Ads
appear in major newspapers seeking kidney donors and offering compen-
sation” (Cohen 2001, p. 21). In China, an organ broker advertised his ser-
vices under the slogan “Donate a kidney, buy the new iPad!” He offered
$4,200 for a kidney and said the operation could be performed within
10 days (Campbell and Davison 2012). In Pakistan, the Aadil Hospital
proudly claims to be the first “ISO Quality Management System certified
hospital in the country” which offers a transplant “package to patients
with end-stage kidney failure”.
In turn, patients who feel they can no longer wait for an organ, and
can afford the cost may turn to black markets which have become trans-
national, sometimes not considering the risks of low quality standards.
‘Organ-importing countries’ are mainly Australia, Canada, Israel, Japan,
Oman, Saudi Arabia and the United States (Scheper-Hughes 2005). Some
countries with less restrictions fuel the demand. Patients, many of whom
will go to China, India, Pakistan or the Philippines for surgery, can pay
up to $200,000 for a kidney to gangs who harvest organs from vulner-
able, desperate people, sometimes for as little as $5,000 (Campbell and
Davison 2012). According to WHO experts, 10,000 black market opera-
tions involving human organs take place each year.
64 F. NAHAVANDI
THE SUPPLY
As is the case for kidneys buyers, there are few well-documented qual-
itative or quantitative research studies on providers. However, the few
in-depth studies in social sciences (Budiani-Saberi and Delmonico 2008;
Cohen 2001, 2003; Goyal et al. 2002; Mendoza 2010; Moazam et al.
2009; Moniruzzaman 2012; Naqvi et al. 2007a, b; Rocafort Gatarin
2014; Scheper-Hughes 2000a, b, 2001a, b, 2005, 2013; Yea 2010) are
rich, reliable and helpful in drawing an overall picture of the situation of
the ‘exporting kidney countries’, the people who undergo the extraction,
the brokers and the medical surroundings. They all tell the same story of
poverty and despair, and illustrate the inequities behind the transactions.
Worldwide, the neoliberal reforms in the health care sector have opened
up markets for selling body parts, celebrating individual control over one’s
own body. Within the Global South, these reforms are encouraging desper-
ate poor providers to risk their lives by selling their kidneys in order to sur-
vive, hence nourishing ‘biocapitalism’ and ‘bioviolence’ (Moniruzzaman
2012). Consequently, a black market for organs has developed exhibiting
many characteristics of an increasingly globalized world whereas slums of
developing countries are transformed into organ farms. Meanwhile, as the
number of donors and the number of countries participating in this mar-
ket grow, the prices of the commodity are falling everywhere, which is the
case in the Philippines where the donors are in such huge supply that they
have to accept the average payment of $3000 for selling their kidneys. The
same happens in Syrian refugee camps, where donors are in competition
and the prices are falling (Putz 2013). In Bangladesh too, the average
quoted price of a kidney ($ 1400) has gradually dropped because of the
abundant supply of body parts from the poor majority (Moniruzzaman
2012, p. 71).
Poverty, the Cradle of Kidney Selling

Without any doubt, the cradle of kidney-selling is poverty, even though
it can be masked by a discourse of ‘saving lives’. As a matter of fact, there
has been in some cases a direct link drawn between catastrophes and the
increase of kidney sales. In 2007, the economic collapse due to Asian
financial crises coincides with a peak of selling and people being trafficked
for the removal and the sale of organs (Rocafort Gatarin 2014, p. 111–
112). Similarly, the tsunami in Indonesia, in 2004, led 150 inhabitant of
Banda Aceh to immediately sell a kidney in order to rebuild their homes

(Courrier International 2009). The traffic of organs takes advantage of all
the misery and vulnerability as well as disasters happening in our world.
Since 2011, Syrian refugee camps in Lebanon where gangs work in the
human organ trade, especially in kidneys, illustrate this reality (Putz 2013)
where the price of a kidney is $ 7000. About one million Syrians have
fled into Lebanon because of the civil war. In their distress, they sell their
organs to gangs that control the operations. Lebanon has a tradition of
illegal organ trading. Prior to the Syrian civil war, it was mostly destitute
Palestinians who sold their organs.
Pakistan’s Sellers
In recent years, Pakistan has emerged as one of the largest centers for com-
merce and tourism in renal transplantation. As a result, serious research
has developed. Naqvi et al. (2007a, b) relate that most kidney sellers in
their survey are from to Punjab in eastern Pakistan, the agricultural heart-
land, where 34 percent of the people live below poverty line, 90 percent
of them are illiterate, 69 percent are bonded laborers who are virtual slaves
to landlords, 12 percent are laborers, 8.5 percent are housewives and 11
percent are unemployed. The majority (93 percent) sold their body parts
for debt repayment, with a mean debt of $1311.4. Post sale, 88 percent
saw no economic improvement in their lives and 98 percent reported
deterioration in their general health status. Future sale was encouraged by
35 percent to pay off debts and freedom from bondage. For the authors,
kidney vendors from Pakistan, many in bondage, are examples of modern-
day slavery. They will remain exploited until law against bondage is imple-
mented and new laws are introduced to ban commerce and transplant
tourism in Pakistan.
Prior to Pakistan’s adoption in 2007 of a law prohibiting such surgeries
on foreigners, the Institute of Urology and Transplantation in the Sindh
province, estimated that beneficiaries of the approximately 2000 annual
kidney transplants, costing about $27,000 each were up to 75 percent
foreigners. Abdul Waheed Sheikh, the chief executive of Aadil Hospital,
who specialized in transplants for foreigners, said the number of ‘medi-
cal tourists’ arriving in Pakistan to receive a kidney plummeted from up
to 500 a month to fewer than 10, since the new regulations were intro-
duced, and regretted that the government turned a $ 1billion medical
tourism industry into a $1 million one. Under the new system, only close
66 F. NAHAVANDI
relatives can donate a kidney in Pakistan, except in rare circumstances and

with federal government permission. Foreigners can still have transplants
in Pakistan but only if they provide their own donor from outside the
country (Azam 2008). In the Philippines, there existed a program of regu-
lated compensated kidney donation from 2002 to 2008 (Padilla 2009;
Paguirigan 2012). However, in 2008 the practice of kidney transplant to
foreigners using unrelated living donors was also banned. As in Pakistan,
the government-issued Administration Order 2008-0004 received a hos-
tile reception from certain medical professionals and government insti-
tutions since the $60 billion global business with an average growth of
20 percent was threatened (Rocafort Gatarin 2014, p. 114). Soon after,
official transplants to foreigners were reduced from 168 in 2008 to three
in 2009. Similarly, between 2002 and 2006, transplantation had increased
about 60 percent. In 2007, 50 percent of kidney transplants were in favor
of foreigners even though according to regulations, only 10 percent of
such operations were allowed (Nouvel Observateur 2008). Nevertheless,
the practice continues.
The Philippines’ Sellers

The Philippines has been another favorite destination for transplant sur-
gery, including kidney. Private companies offer ‘all-inclusive transplant
packages’, covering travel, meals and top-rated hotels and hospitals with
the lowest prices globally (Mendoza 2010, p. 256). The quantitative and
qualitative research led by Mendoza (2010) highlights that 90 percent of
the kidneys are harvested from living donors. The majority of the sellers
are male (Mendoza 2010; Rocafort Gatarin 2014; Yea 2010). Rocafort
Gatarin (2014, p. 109) who has focused on masculinity, contends that
men’s role as providers coupled with the belief that they are more capa-
ble of enduring the risks of kidney removal make them targets for their
organs. Moreover, providers are also young, with the average being in
their early 30s with limited education (Mendoza 2010; Rocafort Gatarin
2014; Yea 2010). In the Mendoza survey, the subjects are equally mar-
ried or single, however in Yea’s study, the majority is married as opposed
to the Rocafort Gatarin study on Baseco, where all are married with up
to 16 children in some cases. The point is that all have, in one form or
another, family responsibilities (wife, children, elderly parents) and are the
only breadwinner. In the Philippines as in other countries, the sacrificial
economy described by Scheper-Hughes (2000a) applies. Kidney providers
usually come from the disempowered classes with annual incomes below
the poverty line, working as farmers, fishermen, tricycle drivers, street ped-
dlers, temporary workers or beggars. However, even in that category, the
worst well-off are often excluded from organ selection, as their health sta-
tus is lower (Mendoza 2010). Many potential providers may even get dis-
appointed, frustrated or even angry over their failure to pass the required
medical tests (Yea 2010). In the Philippines, potential sellers can seek
matching agencies, doctors/hospitals, government foundations, middle
agents and sometimes recipients. However, prospective vendors are usu-
ally connected to recipients by third parties acting as brokers or agents
whose role seems to be central in this country. Finally, as Cohen (2001)
also argued for India, sellers can themselves become brokers.
Lack of information and asymmetry of information about the prices,
the process and its consequences transform the potential providers into
vulnerable individuals, seeking to overcome heavy debts or built a house
(Mendoza 2010; Paguirigan 2012; Rocafort Gatarin 2014). However, the
amounts obtained do not improve their financial conditions or the qual-
ity of life, and sometimes they are cheated and obtain even less than what
has been negotiated (Yea 2010). They usually do not meet the receivers.
The sellers sometimes reconstruct stories about their involvement. They
usually talk about the extrinsic intent of sacrificing something important,
because of their poverty, and the intrinsic intent of sacrificing something
important motivated by altruism usually directed to their family and not
necessarily to extend the life of the recipient. According to the narratives,
the kidney sale is a difficult decision and the consequences are negative:
health deterioration is the main regret, even though the feeling of loss
and not any improvement in living standards is also important (Paguirigan
2012). However, narratives can also highlight how the sellers have been
tricked by other actors involved in the transaction, including medical per-
sonnel, who, in order to convince them, tell them stories like that of a
removed kidney ‘re-growing’ (Rocafort Gatarin 2014). The same maneu-
vering has been detailed in Bangladesh where the brokers tell potential
providers the story of the ‘sleeping kidney’: a person has two kidneys of
which one works and the other sleeps. If one is infected, the other one
starts working. The story is supposed to convince a potential seller that
harvesting is a win-win situation (Moniruzzaman 2012, p. 75).
Finally, in the Philippines like elsewhere, typically, there are little or
no arrangements for the sellers’ post-operative care/check-up. Moreover,
they suffer poor health (Yea 2010). In India, as Cohen (2001) states, the
68 F. NAHAVANDI
situation is similar, as poor post-operative health may impact the ability of

vendors to work. In India, many sellers have permanent damage after the
operation; 86 percent reported deterioration of health, 50 percent com-
plained of pain around the scar and 33 percent experienced back pains.
These complications lead to reductions in income causing a fall below
the poverty line. Even though 54 percent of the sellers were already liv-
ing below the poverty line, the percentage reaches 71 after the operation
(Cohen 2013, p. 272). In Pakistan, 62 percent felt handicapped and could
not work (Cohen 2013, p. 270).
Indian’s Sellers
In India too, transplant surgery is a major business where “patterns of
recruitment, brokerage and harvesting from poor living donors that char-
acterized the maintenance of local blood supplies quickly extended to the
procurement of kidneys” (Cohen 2001, p. 17). The Transplantation of
Human Organs Act of 1994 made it illegal to buy or sell organs and
limited related kidney donation to one’s parent, child, sibling or spouse
with exceptions to be vetted by special authorizations. In India as else-
where, the kidney sellers support their families by sacrificing their part
or are eager to reduce their debt. However, as linked to the tradition of
heavy dowry to be paid by the wife’s family, the dowry can also become a
motivation. In sharp opposition to other ‘exporting kidney countries’, the
sexual distribution of sellers is quite different, as rural sellers are primarily
men and urban sellers are mostly women (Cohen 2001).
Bangladesh’s Sellers
Bangladesh is another country where the tragedy of kidney harvest has
been going on for years. Like in the cases addressed above, in 1999, the
Organ Transplant Act banned any trade in body parts or publishing any
classifieds. Moreover, transgressing can be punished by imprisonment.
However, in Bangladesh organ trafficking continues, with more violence,
more risks and quite always in complete secrecy, even hidden from the
family. The difference between this case and others is that kidneys pro-
vided by nationals, and often bought by local recipients, are brought to
other countries in order to get transplanted. Moniruzzaman’s ethnogra-
phy (2012) is mainly focused on the sellers, and the result of the trans-
plant on their physical, psychological, social and economical situation and
hence, on the violence of the process. In Bangladesh, the brokers and

their tricky procedures seem to be very important. And beyond poverty,
manipulation is also responsible for the sale. As Bangladeshi sellers often
cross the boarders to have surgery, the range of false promises, lures and
threats and coercion are much more present than in other cases. Here,
sellers are trapped in a situation they neither can control, nor abandon.
Moreover, they often do not receive the promised amounts. The post-
operative phase and post-vending times are rife with sorrow and suffering.
Furthermore, the social stigma, in case the operation is revealed, is high
and the poor seller’s self-value is low. The paid amounts, as elsewhere,
are mainly used to pay off debts or dowry and few sellers have benefitted
from it to improve their economic situation. Kidney sellers become, as
Moniruzzaman (2012, p. 79) labels them, ‘living cadavers’. His ethnog-
raphy proves that, besides deterioration of health documented by other
studies, the social standing of sellers declines sharply and that furthermore,
there are profound psychological and psychosocial impacts, especially in
relation to selfhood (Moniruzzaman 2012, p. 79). All those factors lead
to social isolation.
Other Countries’ Sellers

According to the United Nations, Egypt is now becoming one of the coun-
tries most affected by organ trafficking, right after China, the Philippines
and India (Guibal 2009). In the slums of Cairo, a kidney bought for about
$3000 can be sold up to six time its price. Each year, 500 transplants are
officially made in Egypt, with 90 percent coming from sellers. As else-
where, field research in Egypt reveals the neglect of the welfare of the
impoverished kidney vendors, the deterioration of their health, and no
improvement in financial situations, as kidneys are often sold to pay off
debts rather than to improve the quality of life. Hence, the majority of
vendors regret their act (Budiani-Saberi and Delmonico 2008).
In 2013, an organ trafficking ring in Turkey that was operating across
the country was discovered. The traffickers were purchasing livers and
kidneys for $10,000 from people who wanted to sell their organs and
found the buyers through postings on the Internet. The organs were then
sold to medical patients who needed the organs and in turn paid up to
$20,000 (Hürriyet Daily News 2013). In China, in lieu of a public donor
system, demand has long been met by harvesting organs from executed
criminals, despite criticism from human rights advocates who questioned
70 F. NAHAVANDI
the degree of consent. There are also many reports that organs have come
from prisoners of conscience, especially Falun Gong members, not crimi-
nals on death row (Cook 2015). In China, the shortage of organs, partly
due to the tradition of burying the whole body, has given way to a parallel
economy. An online plea can put a desperate patient or a donor short of
money in touch with agents exploiting a shortage of human organs who
deal with corrupt doctors and hospitals (Davidson 2012). China’s official
policy has changed since January 2015, when it began to allow voluntarily
donated organs from civilians to be used in transplants.
Finally, the Islamic Republic of Iran represents a very unique case in
treating kidney transplantation. It is the only country with a regulated
market and a state-sponsored system of financial remuneration for kidney
(and liver portions) among nationals, and the only country to adopt a
compensated living unrelated donor (LURD) renal transplantation pro-
gram. Moreover, in Iran, policies surrounding organ donation require that
not only the seller and the recipient identities are released, but also that
they meet and can opt to continue contact after transplantation (Tober
2007). These requirements are quite unique as, in the other cases previ-
ously addressed, the seller’s invisibility is often the rule. Iranians are not
allowed to donate kidneys to non-citizens, and it seems the experiment
has not flowed onto creating commercial organ trafficking across Iranian
national borders. However, in Iran, foreigners can receive transplant from
living related donors or volunteer living donors of the same nationality.
Otherwise, people can sell and buy kidneys under the state-regulated
surveillance of two non-profit organizations: the Charity Association for
the Support of Kidney Patients (CASKP) and the Charity Foundation for
Special Diseases. These charities facilitate the process by finding potential
vendors and introducing them to the recipients, and are charged with
checking the compatibility of a possible donation and ensuring a fair trade.
As a result, there is no shortage of organs. However, if apparently preced-
ing the development of the current system, there was no black market in
Iran, it emerged afterwards. The Iranian case demonstrates that even a
state-regulated market does not prevent black market activities and exploi-
tation, a reality which reflects that the main motivation of the sellers is
poverty. Nowadays, competition among sellers has grown. Moreover, to
overcome procedures, non-official direct negotiations have transformed
the Iranian system into a kidney market. Would-be sellers advertise their
kidneys by writing their blood type and phone number on posters or walls
of the streets close to several of Tehran’s major hospitals. At the heart of
the capital, near the CASKP, the number of advertisements is increasing.

Also, many potential donors line up outside the CASKP, hoping to find
wealthy people in need of kidneys who may be willing to make private
arrangements. The Iranian government does not sanction these private
arrangements; however, they constitute a black market trade, considered
as illegal in Iran (Tober 2007, p. 159–160). Economic crisis has increased
such behavior. Whatever the scheme, the Iranian case confirms the donors
are not really more protected than elsewhere, as they are also deprived of
post-operative care and not able to work for a couple of months (Kamali
Dehghan 2012). Zargooshi (2001a, b) documents how Iranians sellers
suffer from depression, low self-esteem and familial conflict, and to what
extent their economic situation has declined because of their bad health
status, and how it impacts their future work.
To close this chapter, it can be concluded that, even though kidney
transplant is a life-saving technology, organ trafficking has transformed it
into big business. In this process, people with the money to pay for a new
life use a new resource mostly from the Global South’s body. Thus, the
commodification of the kidney turns it into an object of consumption.
It illustrates a reality by which female and male consumers use strangers’
kidney to fill in a body failure. Moreover, kidney transplantation illustrates
the process by which the citizen-consumers of the global market depend
on the extraction of a part of producers-workers on whose backs they
gain life. In turn, the kidney transplant can also be considered as another
form of ‘bioviolence’, “an instrument which transforms human bodies,
either living or dead, either whole or in parts, as sites of diverse exploi-
tation viable through new medical technologies” (Moniruzzaman 2012,
p. 69), a business in body parts that contributes to the global capitalism’s
objectification of the Global South’s body, in a world where increasingly
everything can be bought.
REFERENCES
Azam, Z. (2008, May 12). Kidney market shuts as Pakistan cuts supply. The Sidney
Morning Herald. Retrieved October 26, 2014, from http://www.smh.com.
au/news/national/kidney-market-shut-as-pakistan-cuts
Bagheri, A. (2010). Global health regulations should distinguish between medical
tourism and transplant tourism. Global Social Policy, 10(3), 295–297.
Baker, C. F., & Markmann, J. F. (2013). Historical overview of transplantation.
Cold Spring Harbor Perspectives in Medicine, 3(4), a014977. Retrieved July 23,
72 F. NAHAVANDI
2015, from http://perspectivesinmedicine.cshlp.org/content/3/4/a014977.

full.
Budiani-Saberi, D. A., & Delmonico, F. L. (2008). Organ trafficking and trans-
plant tourism: A commentary on the global realities. American Journal of
Transplantation, 8(5), 925–929.
Campbell, D., & Davison, N. (2012, May 27). Illegal kidney trade booms as new
organ is sold every hour. The Guardian. Retrieved January 16, 2015, http://
www.theguardian.com/world/2012/may/27/kidney-trade-illegal-
operations-who
Cohen, G. (2013). Transplant tourism: The ethics and regulations of international
market for organs. Global Health and the Law, 41(1), 269–285.
Cohen, L. (2001). The other kidney: Biopolitics beyond recognition. Body &
Society, 7(2–3), 9–29.
Cohen, L. (2003). Where it hurts: Indian material for an ethics of organ transplan-
tation. Zygon, 38(3), 663–688.
Cook, M. (2015). Controversial doco investigates China’s organ donation system.
BioEdge. Retrieved July 24, 2015, from http://www.bioedge.org/bioethics/
controversial-doco-investigates-chinas-organ-donation-system/11391
Courrier International. (2009, January 29). 952. Retrieved February 1, 2014,
from http://www.courrierinternational.com/article/2009/01/29/le-trafic-d-
organes-se-porte-bien
Davidson, N. (2012, May 27). Illegal kidney trade booms as new organ is sold
every hour. The Guardian. Retrieved February 1, 2014, from http://www.
theguardian.com/world/2012/may/27/kidney-trade-illegal-operations-who
Garwood, P. (2007). Dilemma over live-donor transplantation. Bulletin of the
World Health Organization, 85(12), 5–6.
Goyal, M., et al. (2002). Economic and health consequences of selling a kidney in
India. JAMA, 288(13), 1589–1593.
Guibal, Cl. (2009, April 23). L’Egypte malade du trafic d’organes. Libération.
Retrieved January 5, 2013, from http://www.liberation.fr/
monde/2009/04/23/l-egypte-malade-du-trafic-d-organes_554169
Hürriyet Daily News. (2013, October 9). Twenty-six alleged organ trafficking
gang members detained in Turkey. Retrieved January 16, 2015, from http://
www.hurriyetdailynews.com/twenty-six-alleged-organ-trafficking-gang-
members- detained-in-turkey.aspx?pageID=517&nID=55964&NewsCa
tID=341
Kamali Dehghan, S. (2012, May 27). Kidneys for sale: Poor Iranians compete to
sell organs. The Guardian. Retrieved February 1, 2014, from http://www.
theguardian.com/world/2012/may/27/iran-legal-trade-kidney
Manzano et al. (2014) The invisible issue of organ laundering. Transplantion,
98(6), 600–603.
Mendoza, R. L. (2010). Kidney black markets and legal transplants: Are they
opposite sides of the same coin? Health Policy, 94, 255–265.
Moazam, F., et al. (2009). Conversations with the kidney vendors in Pakistan: An
ethnographic study. The Hastings Center Reports, 39(3), 29–44.
Moniruzzaman, M. (2012). ‘Living cadavers’ in Bangladesh: Bioviolence in the
human organ bazaar. Medical Anthropology Quarterly, 26(1), 69–91.
Mousourakis, G. (2010). Body commodification and human organ transfer in the
biotechnology age: Philosophical and ethico-legal perspectives. Housei Riron,
43(1), 45–65.
Naqvi, A., et al. (2007a). A socioeconomic survey of kidney vendors in Pakistan.
Transplant International, 20(11), 934–939.
Naqvi, S. A., et al. (2007b). A socioeconomic survey of kidney vendors in Pakistan.
European Society of Organ Transplantation, 20(11), 934–939.
Nouvel Observateur. (2008). Nouvel Obs.com 29/04/08 – BioEdge 01/05/08.
Padilla, B. S. (2009). Regulated compensation for kidney donors in the Philippines.
Current Opinion in Organ Transplantation, 14, 120–123.
Paguirigan, M. S. (2012). Sacrificing something important: The lived experience
of compensated kidney donors in the Philippines. Nephrology Nursing Journal,
39(2), 107–117.
Putz, U. (2013). Lebanese black market: Syrian refugees sell organ to survive.
Spiegel Online. Retrieved October 26, 2014, from http://www.spiegel.de/
international/world/organ-trade-thrives-among-desperate-syrian-refugees-in-
lebanon-a-933228.html
Rocafort Gatarin, G. (2014). Masculine bodies in biocapitalist era: Compromising
human rights of commercial kidney donors in the Philippines. Gender,
Technology and Development, 18(1), 107–129.
Scheper-Hughes, N. (2005, January-February 26–27). Organs without borders.
Foreign Policy, 146.
Scheper-Hughes, N. (2013, September 13). Organ trafficking: A protected crime.
The Conversation. Retrieved January 11, 2015, from https://theconversation.
com/organ-trafficking-a-protected-crime-16178
Scheper-Hughes, N. (2000a). The global traffic in human organs. Current
Anthropology, 41(2), 191–224. Retrieved January 5, 2014, from http://pascal-
froissart.free.fr/3-cache/2000-scheperhughes.pdf.
Scheper-Hughes, N. (2000b). Commodification of the body and its parts. Annual
Review of Anthropology, 29, 287–328.
Scheper-Hughes, N. (2001a). Body for sale-whole or in parts. Body & Society,
7(1), 1–8.
Scheper-Hughes, N. (2001b). Commodity fetishism in organs trafficking. Body &
Society, 7(2–3), 31–62.
Scheper-Hughes, N., & Roberts, E. (2011). Introduction: Medical migrations.
Body and Society, 17(2–3), 1–30.
74 F. NAHAVANDI
Sharp, L. (2007). Bodies, commodities, and biotechnologies: Death, mourning, and

scientific desire in the realm of human organ transfer. New York: Columbia
University Press.
Tober, D. (2007). Kidneys and controversies in the Islamic Republic of Iran: The
case of organ sale. Body & Society, 13(3), 151–170.
Watson, C. J. E., & Dark, J. H. (2012). Organ transplantation: Historical perspec-
tive and current practice. British Journal of Anaesthesia, 108(S1), I29–I42.
Wilkinson, D. (2008). Body shopping, converting parts to profit. Oxford:
A Oneworld Book.
Wilkinson, S. (2012). The sale of human organs. IN Zalta E.N. (Ed) The stanford
Encyclopedia of Philosophy. Retreived December 4, 2016 from: http://plato.
stanford.edu/archives/fall2012/entries/organ-sale/
World Health Organization. (1991). World Assembly. Resolution WHA42.5
Guiding Principles on Human Organ Transplantation.
Yea, S. (2010). Trafficking in part(s): The commercial kidney market in a Manila
slum Philippines. Social Policy, 10(3), 358–376.
Yee, J. (2012). European crisis boosts illegal trade in body parts. BIOEDGE.
Bioethics news from around the world, 9 JUne. retreived April 10, 2016 from
htpp://bioedge.org
Zargooshi, J. (2001a). Quality of life of Iranian kidney ‘donors’. Journal of
Urology, 166, 1790–1791.
Zargooshi, J. (2001b). Iranian kidney donors: Motivations and relations with
recipients. Journal of Urology, 165, 386–392.
CHAPTER 6
Transnational Attraction of Brains
Abstract Chapter 6 explores new targeted policies in the Global North

that aim to attract—and one would argue, extract—the most talented citi-
zens of the Global South. This process has become known as ‘the attrac-
tion of brain’, which appears as a way to respond to the human capital
shortage. Nahavandi argues that it reflects another example of the silent
extraction of resources from the Global South. It has given way to increas-
ing competition between states as a way to remain in the global race for
talent. This chapter offers an overview of the selective migrations policies
conceived to attract the ‘brains’ from abroad together with their conse-
quences in some exporting countries.
Keywords Migration • Brain drain • Highly skilled migrant • Selected

migration policy • Human capital • Race for talent • Point system •
Graduate student • Poverty
THE ISSUE
Migration is not a new phenomenon even though it can be considered
as one of the defining issues of the twenty-first century, and a feature of
today’s mobile world. At present, migration, as many other phenomena,
has become trapped in a neoliberal logic that favors market solutions to
manage social phenomenon (Schmidtke 2012). From that perspective, a
new dimension in the migration policies of the Global North can be high-

DOI 10.1057/978-1-137-50584-2_6
76 F. NAHAVANDI
lighted: the increased interest in highly skilled migrants and their know-
how as a way to respond to human capital shortage. While general labor
mobility between countries is constrained by restrictive rules and policies,
new targeted immigration policies are growing by way of which the most
talented people of the Global South are being attracted to work in the
Global North, an extended and modern version of old times patronage. A
new turn that explains why citizenship and residence permits are typically
becoming important recruiting tools (Shachar 2011, p. 2102). This chap-
ter focuses on a phenomenon, called hereinafter the ‘attraction of brains’
and argues that it embodies another example of the silent extraction of
resources from the Global South, a process, which will probably become an
important development issue in the future. Indeed, whenever states com-
pete for the world’s qualified workers (information technology specialists,
engineers, physicians, nurses and so on), and immigration policies of the
wealthiest ones offer various mixes of opportunities, and are conceived to
selectively attract the ‘brains’ from abroad, then the latter also becomes an
issue that can be considered as part of the commodification of the body’s
process: migrants are only considered for their know-how (brain). This evo-
lution is progressively engendering ethical concerns similar to those related
to the commodification of hair, womb or kidney (Borna and Stearns 2002).
Therefore, in frame of international competition and market-oriented poli-
cies, the attraction of brain is far from being an anodyne phenomenon. It
results from disparities between countries and a process through which the
strongest and wealthiest among them use mostly the brains of citizens from
the poorest and weakest parts of the world to their advantage, and benefit
from it to consolidate their power. Nowadays, selective migration regimes
are strong signs of an existing market for talents, and the rise of a global
‘race for talent’ as a way to secure its rank in an increasingly competing
world. “There are good reasons to believe that the contest for talent will
intensify during the next few decades. Skill biased technological change
and, perhaps to a lesser extent, the growing specialisation of developed
countries in human capital-intensive activities as a result of globalisation
will raise the demand for highly skilled labour” (Bertoli et al. 2009).
THE DEMAND
One of the key features of twentieth-century international migration has
been ‘brain drain’. The term was popularized in the 1960s along with the
disturbing observation of a loss of skilled labor power from the poorest to
the richest countries. Brain drain refers to the transfer of resources in the
TRANSNATIONAL ATTRACTION OF BRAINS 77
form of human capital and applies usually to the migration of highly skilled
individuals from developing to developed countries (Boeri et al. 2012). In
the international literature, highly skilled migrants are commonly defined
as those with a tertiary degree (OECD 2004; Chaloff and Lemaitre 2009).
Today, the brain drain has re-entered the development debate, and in light
of a highly competitive global knowledge economy, the migration of the
highly qualified is becoming a major issue for both OECD countries and
developing countries (Hartmann and Langthater 2009). As a matter of
fact, since the end of twentieth century, along with the brain drain, an
increasing demand for highly skilled workers can be observed in the Global
North (Antecol et al. 2004; Bosi et al. 2008; Carr et al. 2005; Boeri et al.
2012; Facchini and Lodigiani 2014; Kapur and McHale 2005; Koslowski
2013). Based on the European case, Schmidtke (2012, p. 32–33) high-
lights a utilitarian shift of depicting migrants as mere subjects of economic
interests and argues, “The migrants provide a form of ‘human capital’ that
has become an increasingly rare resource within European societies”. A
statement that is consistent with the definition of the commodification of
this book: to commodify is to take something of intrinsic worth (such as
‘persons’) and to objectify it by giving it a use value (so it has—or is sub-
jected to processes that liken it to—the status of ‘things’).
The demand for highly skilled labor has been explained in many ways.
Kapur and McHale (2005, Chap. 5) discuss the increasing focus on the
more skilled in the context of ‘big trends’ that are likely to have implica-
tions for the economics and politics of alternative strategies: the skill-biased
technical change, the population aging, and the broader globalization.
The first trend is linked to the fact that new technologies in areas such
as computing and medicine are making educated workers more valuable,
leading governments everywhere to declare that they want more of them.
It also springs from a ‘shortage’ of highly skilled labor (Bauer et al. 2004).
The second trend is based on the reality that over the coming decades, the
share of elderly in the population will rise rapidly owing to the increasing
life expectancies as well as the aging of the post-World War II Baby Boom
generation, which has the potential to roil labor markets and strain social
security systems. The third trend is linked to the increased international
integration of products and capital markets. Each of these three trends is
changing the economic and political calculus for immigration policies, and
is having an impact on the international competition for talent. As a result,
selective migration policies have proliferated worldwide, as governments
try to attract mostly scientists, highly skilled engineers, medical profession-
als and information technology professionals (Koslowski 2013). A market
78 F. NAHAVANDI
for talent is being installed where governments see themselves as com-

peting for internationally mobile human capital via immigration policies.
Furthermore and progressively, governments in high-income countries
and emerging economies alike have come to subscribe to the view that in
order to secure a position in the pantheon of excellence, it is the ability to
draw human capital, to become an ‘IQ magnet’, that counts (Shachar and
Hirschl 2013; Shachar 2009, 2011). In fact, as Shachar and Hirschl state
(2013), the spiraling race for talent is one of the most significant develop-
ments in recalibrating international migration and mobility in today’s glo-
balizing world. A process they have labeled ‘picking the winners’ and the
‘global race for talent’. In consequence, the percentage of highly educated
among the immigrant population has been growing over the past decade
in most OECD countries. The share is now highest in Canada, where
over 50 percent of the immigrants have tertiary education. On average
throughout the OECD, in 2010/2011, about 30 percent of immigrants
have a tertiary education, compared with less than 25 percent in 2000.
Selective Migration Policies

“Legal strategies play a significant role in today’s global race for talent
by turning national goals onto actionable plans, and cogently manifest-
ing the strategic interactions among the key contenders in today’s fierce
inter-jurisdictional competition for the best and brightest” (Shachar and
Hirschl 2013, p. 73). Countries seeking to lure international talents adopt
proactive measures. The OECD policies reveal a wide range of intensity in
countries’ approach to the international mobility. These policies are mani-
fold, as economic incentives to encourage inflows, immigration-oriented
assistance, procedures for recognizing foreign qualifications, social and
cultural support, and support for research abroad. Some countries focus
on just a few policy mechanisms, while others offer “something for every-
one” (OECD 2008). Whatever the form, a United Nations survey (2010)
highlights that 47 percent of the developed participating countries indi-
cated that they have policies to increase immigration of highly skilled.
individuals. “Picking winners comes very close to resembling headhunting
practices, turning immigration officials and other policymakers, as well
as public and private actors with devolved authority, into enterprising
recruiters of super talent” (Shachar and Hirschl 2013, p. 87). In turn,
potential movers can be attracted by income, job availability, tax rates,
public benefits, public services, language, political and legal rights, dia-
sporic networks and so on (Kapur and McHale 2005, p. 38).
Immigration market propositions fall into two main types, determined
by whether they offer permanent or temporary residence. In turn, policy
instruments can be broadly classified as immigrant-driven or employer-
driven (Chaloff and Lemaitre 2009; Facchini and Lodigiani 2014).
Koslowski (2013, p. 26) argues that selective migration policies can be
grouped in three ideal-typical models: the Canadian ‘human capital’
model based on state selection of permanent immigrants using a point
system; the Australian ‘neo-corporatist’ model based on state selection
using a point system with extensive business and labor participation; and
the market-oriented demand-driven model based primarily on employer
selection of migrants, as practiced in the United States. Australia, Canada
and New Zealand have introduced, in one way or another, a point system,
which aims to select skilled migrants who offer the best in terms of eco-
nomic benefit. The United States has an ‘extraordinary ability category’ in
its immigration law. In Europe, the United Kingdom, Denmark and the
Netherlands have also introduced a point system selection, which deter-
mines the desirability of a person. Increasingly, know-how grants higher
points in the selection.
Among Western countries, skill-selective policies already have a long
history in traditional destination countries as Australia, Canada, New
Zealand and the United States, which have well-established policies to
permanently admit immigrants on the basis of their human capital and job
offers. European countries are newcomers to the competition for highly
skilled mobile talent as they have traditionally focused on recruiting man-
ual workers from abroad (Kapur and McHale 2005). However, since the
end of 2000s efforts have been undertaken to coordinate policy at a supra-
national level in order to make the region more attractive for highly skilled
foreign workers.
Canada developed a point system in the 1960s for selecting permanent
immigrants based on their predicted economic contribution (Green and
Green 1999) and reshaped the policy in the 1990s with points given mostly
to work experience, education, language ability in English and French,
flexibility, adaptability and experience in any skilled occupation. Canada’s
policy turned from a short-run migration model to a human capital per-
spective, aiming at selecting younger skilled workers who can integrate
rapidly in the Canadian labor market and benefit the country. Canada’s
point system is flexible and permits the “immigration policymakers to
80 F. NAHAVANDI
change the pass mark in order to better respond to the needs of foreign-
born professionals that the country is seeking to attract” (Shachar and
Hirschl 2013, p. 128).
Australia operates a hybrid selection system for skilled migrants
including both a points-based system and employer sponsorship options
(Papademetriou and Sumption 2011). The point system was introduced
in 1989 and reformed in the 1990s seeking to increase the average skill
level of migrants by focusing more on those who can demonstrate they
will bring professional, trade or business skills. Age plays a large factor in
whether an application will succeed as does competency in English lan-
guage. Furthermore, skilled employment and educational qualification
stand high on the list of granting points (Hawthorne 2005). Additional
points are given to the applicants with an occupation on the Migration
Occupation in Demand List, or with a job offer and furthermore to those
who have Australian educational qualifications and experience. In 2009,
in the wake of the global financial crisis, a shift in focus away from supply-
driven independent skilled migration towards demand-driven outcomes,
in the form of employer and government-sponsored skilled migration was
reinforced. Compared to other factors, the share of skilled workers enter-
ing Australia is growing. In this country, it is the government that sets
the targets for people to be admitted together with industry cooperation
and with labor. The model is a combination of immigrant- and employer-
driven schemes. Successful entrepreneurs can be admitted through a
business skills migration scheme, whereas exceptionally talented individu-
als can have access to the distinguished talent framework (Facchini and
Lodigiani 2014, p. R6-7).
New Zealand amended its migration policy in the 1970s towards entry
granted on basis of existing demand for skills and qualifications (Bedford
et al. 2001; Bedford 2003). Under the Immigration Policy Review of
1986, any person who had received a job offer for employment in one
of the jobs listed under the Occupational Priority List was eligible for a
residence permit (Facchini and Lodigiani 2014, p. R7). The Immigration
Amendment Act of 1991 introduced a migrant-driven scheme based on
a point system for the general skill category of migrants replacing the
occupational priority list, and abandoning the requirement of a job offer.
In 2003, another change was introduced focusing on short-term labor
market considerations (New Zealand, 2009) and a talent visa under the
work-residence program was created.
In the United States, there is no point system and the main instru-
ment to admit skilled workers is the H-1B visa, introduced with the 1990
Immigration Act, which targets workers to be employed in ‘specialty
occupations’, defined as those requiring theoretical and practical applica-
tions of specialized knowledge, like engineering or accounting. It gives
the opportunity to work for a limited period of time, but also permits
sponsored holders to apply for permanent resident status. The 1990 Act
also introduced O visas for workers of extraordinary ability in the sci-
ences, education, business or athletics and P visas for internationally rec-
ognized entertainers and athletes. The United States model is considered
a typical employer-driven system and market demand-driven model. In
1996, H-1B was expanded and in 2005, an ‘advanced degrees exemp-
tion’ allocating additional visas to applicants with advanced degrees from
United States universities was created. Highly skilled temporary migrants
also enter on L visas issued for intercompany transfers. It is considered
that between 20 and 50 percent of H-1B visa holders adjust their status to
permanent residence each year, and 90 percent of employment-based per-
manent resident cards are issued to individuals who entered the country as
foreign students and temporary workers (Lowell 2000).
Within the European Union (EU), immigration of non-European citi-
zens is still largely the domain of national policies of each member state.
However, new policies have been introduced at the EU level with the
objective of attracting highly skilled individuals from abroad (Mahroum
2001; Kahanec and Zimmermann 2010), among others the adoption of
the EU Blue Card directive in May 2009 (Facchini and Lodigiani 2014)
OECD 2015, p. 158, which demonstrated the EU’s eagerness to compete
for global talent. The EU Blue Card, a typical employer-driven initiative,
is a residence permit allowing its holder to work and live in a European
country. It applies only to highly skilled workers who are not nationals of
one of the European Economic Area’s member states. The card is pro-
vided to individuals admitted under the migration program, and requires
the existence of a work contract, high professional qualifications and a
salary above a minimum set at the national level. However, it also aims
to manage effectively the influx of migrants to the EU considering the
demographic shift and the labor shortage prevailing in the member states.
At a national level, European countries have increasingly focused their
immigration policies on attracting highly skilled individuals from outside
of Europe. France applies a discretionary consideration to the ‘added
value’ of hiring a foreign worker expressed in terms of any new skills or
82 F. NAHAVANDI
resources represented by the candidate for France (Chaloff and Lemaitre

2009). Like many European countries, France has a long history of immi-
gration, however from 2000 onwards, labor migration has been given
much emphasis. The 2006 and 2007 immigration and integration laws
contain provisions which explicitly encouraged highly skilled migration
(Facchini and Lodigiani 2014). They include a three-year work permit for
educated professionals such as scientists, executives and academics. The
2006 legislation introduced a skill and talents visa which is not subject to
any numeric restriction. The eligible candidates must be able to demon-
strate that they will contribute to the economic or intellectual and cultural
development of both France and their country of origin. Interestingly,
the French government, according to the law, will only issue a visa to
those skilled immigrants from a developing country that has signed a
‘co-development’ agreement with France, or if the immigrant agrees to
return to the home country within six years. France has also introduced
fiscal incentives for foreign professionals. The last French President’s 2012
National Pact for Growth follows the same objectives.
The United Kingdom is not a traditional immigration country and up
to 1980s it has even been a net emigration country. Its immigration policy
has long been a point-based system. Nowadays, it is a mix of immigration-
driven and employer-driven policies (Bertoli et al. 2009; Chaloff and
Lemaitre 2009; Facchini and Lodigiani 2014; Kapur and McHale 2005).
In early 2002, a Highly Skilled Migrant Program with visas granted for a
period of one year, extendable for an additional three years was launched.
The program offered the possibility to apply for permenant residence after
four years. In 2003, age and qualifications were granted extra points. The
system was reformed in 2008 by the introduction of a five-tier program.
Under the latter, tiers 1 and 2 were reserved for skilled migrants. Tier 1
allows talented individuals to enter the country without the need of an
existing job offer. Tier 2 is reserved for medium and highly skilled work-
ers and requires a job offer. The point system favors langage ability, funds
available to support the migrant, age, academic qualifications, work expe-
rience in the United Kingdom and previous earnings.
Germany is also characterized by a point-based system for permanent
skilled immigration. In particular, in 2000, it launched the Green Card ini-
tiative aimed to overcome the shortage of Information and Communication
Technology specialists. The comprehensive German Immigration Act of
2005 followed, aiming also to attract highly skilled workers especially sci-
entists, university professors, outstanding sportsmen and artists (Facchini
and Lodigiani 2014) and high-income managers and specialists. All these
categories were entitled to residence permits. Currently, in Germany, the
EU Blue Card is the only residence permit for skilled workers. The hold-
ers can apply for residence after three years, reduced if they have German
language ability.
Taking into consideration the above examples of OECD countries,
it can be concluded that immigration policies of high-income industrial
countries are becoming increasingly based on skills selections as a criteria.
This is growing evidence of a ‘shortage’ perceived in many important fields
for international competition, which by the process of immigration favors
the talented, while at the same time it leaves the weakest behind. “With
circumscribed employment rights, the increased significance of temporary
migrant workers underscores arguments that globalisation has engendered
a more profound commodification of labour” (Rosewarne 2010, p. 99),
and “growing groups of migrants are prone to be treated as an adaptable
and dispensable commodity” (Schmidtke 2012, p. 33).
International Graduate Students’ Policy

Together with selective migration policy measures, in the race for talent, a
trend to encourage foreign graduate students to stay in the Global North
is also growing, and international student policy has now become a tool
in the international competition for the highly skilled. There are two main
channels by which foreign students are used as a talent pool: by allowing
them to work during their studies, and by allowing status changes after
their studies (Chaloff and Lemaitre 2009). Recently, many countries have
changed their rules in this regard. A large number of OECD countries
have established pathways for foreign graduates to become labor migrants.
International students account, on average, for more than 6 percent of
all students in OECD countries. In particular, Chinese and Indian students
(25 percent) are an important source of future labor migration (OECD
2012). Since 2011, graduates from Austrian universities may be granted
a visa to look for a job in Austria. Family members also receive full labor
market access (Fassmann and Reeger 2008). Furthermore, international
students graduating from Austrian universities are allowed to change their
status to permanent residents if they find highly skilled work. Since 2011,
New Zealand awards international students points for residence under
the skilled-migrant category (OECD 2013a, b, c, d; Hodgson and Poot
2010). Meanwhile, Canada invites up to 1000 foreign nationals currently
84 F. NAHAVANDI
studying for a PhD or recently graduated to apply under the temporary

foreign worker program (MacDonald 2013). In France, 2006 legislation
encouraged Masters graduates of the highest ability to stay on and find
employment which “directly or indirectly benefits the economic develop-
ment of France and the student’s home country”. These so-called ‘high-
potential’ students receive a provisional non-renewable authorization to
stay for six months, to seek a job in their field of study. After six months, if
the graduate has or is promised a job paying at least 150 percent the mini-
mum wage, a temporary permit is granted without requiring a labor mar-
ket test. Students who do not hold a Masters degree or who have found
work in a different field from the studies, or one which pays too little, are
allowed to apply under the general permit system (Chaloff and Lemaitre
2009). France allows those with higher educational qualifications to stay
and gain work experience in their specialized field, as temporary workers
(OECD 2013a, b, c, d). In the United Kingdom, policy towards inter-
national students and the labour market has also undergone fundamental
changes. In 2007, the International Graduate Scheme (IGS) was launched
to replace the more limited Science and Engineering Graduate Scheme
(SEGS). This was a precursor to the tier 1 post-study category, and a
response to the drive in a number of countries to compete for the reten-
tion of growing numbers of international students. The IGS enabled all
non-European economic area students who successfully completed their
degree (regardless of discipline) at an approved higher education institu-
tion in the United Kingdom to remain in the country for up to 12 months
and compete for work. Later, the government announced a change of its
post-study route into the labor market starting in 2012. Now, students
who have engaged in innovative entrepreneurial activity during their stud-
ies may stay on afterwards to develop their business ideas. In 2006, the
Netherlands took steps to enlarge the residence opportunities for interna-
tional students after the completion of their studies. The Dutch govern-
ment grants foreign students the opportunity to stay in the Netherlands
and seek high-skilled work for up to three months after graduation. As in
Austria, if they find highly skilled employment, they receive a residence
permit. In Norway (Van Riemsdijk and Cook 2013), large companies
design projects for graduate students, and offer summer internship for the
advanced undergraduates. The initiatives allow students to become famil-
iar with the company and acquire skills. In return, the companies hope
that the most promising students will stay on after graduation.
Besides immigration policies aimed at attracting brains, and policies to

maintain talented foreign students, there has been a growth of recruit-
ment agencies often called upon by companies when they need short-
term labor for project work. ‘Body shopping’, the Indian practice whereby
an Indian-run consultancy (body shop) anywhere in the world recruits
information technology workers, in most cases in India, to be placed as
project-based labor with different clients (Xiang Biao 2007), illustrates
this practice. Among others, using recruitment agencies in Norway is
also getting popular, especially in the oil and gas industry (Van Riemsdijk
and Cook 2013). Even though it is more expensive to hire an employee
through that channel, a company can save money long-term by minimiz-
ing redundancy in its workforce (Van Riemsdijk and Cook 2013, p. 23).
The recruitment agencies are actively involved in the career decisions of
their hires, hoping to employ them for a long time. Furthermore, the
larger ones have access to an international database of skilled workers, and
they can tap into a network of colleagues in other countries.
THE SUPPLY
A recent report of the International Labor Organization (2014) high-
lights, “Trade liberalization and investment in infrastructure and educa-
tion have long been regarded as the key drivers of economic development.
However, this approach has failed to address the vulnerable economic
growth patterns typically found in many developing countries, rising
youth unemployment – including among graduates, and widening income
inequalities”. According to the report, while it has long been argued that
developing countries should concentrate efforts on trade and investment
liberalization and infrastructure spending, supported by external aid if
needed, evidence shows that such policies will not yield development
unless accompanied by dedicated efforts towards employment and decent
work opportunities. The report also explains that the lack of quality jobs
is a central determinant of emigration, especially among educated youth
in developing countries. Interestingly enough, the need to include inter-
national migration in the post-2015 development strategy, which replaces
the Millennium Development Goals, is also underscored (ILO 2014).
However, until these goals are achieved, it is likely that migration flows
will go on, particularly highly skilled individual migration, so far as their
profile corresponds to a growing demand in the Global North, and that
86 F. NAHAVANDI
many developing countries have invested massively in university education

over the past 40 years.
A Trend Towards Highly Skilled Migration

In the United States, where nearly 60 percent of PhD scientists and engi-
neers are foreign-born (Freeman 2010, p. 397), “In terms of quantity,
immigrants generally account for about a quarter of the U.S. workforce
engaged in science, technology, engineering, and mathematics (STEM)
fields. This share is growing rapidly” (Kerr 2013), while all over the world,
the existing data illustrate that the migration of highly skilled is raising
sharply. Furthermore, emigration rates of the highly skilled have exceeded
total emigration rates for most countries of origin, reflecting the selective
nature of migration. The Organization for Economic Co-operation and
Development and United Nations Departement of Economic and Social
Affairs (OECD-UNDESA) figures (2013) indicate that the number of ter-
tiary-educated immigrants in the OECD increased by 70 percent in the past
decade to reach 27 million in 2010-11. About 30 percent of all migrants
in the OECD area were highly educated, a trend mostly driven by Asian
migration, with one-fifth originating from India, China or the Philippines.
At the same time, one in every nine persons born in Africa with a ter-
tiary diploma lived in the OECD (2013). Corresponding figures for Latin
America and the Caribbean and Asia were one in 13 and one in 30, respec-
tively. All data also converge in showing the migration of the highly skilled
is more acute in countries with small populations and island states, but
lower in populous non-OECD countries. In 2010, close to 90 percent of
highly skilled persons born in Guyana lived in OECD countries. Similarly,
more tertiary-educated persons were living outside Barbados, Haiti and
Trinidad and Tobago than their home countries. The proportion of
highly educated persons residing in OECD countries was also significant
for Jamaica (46 percent), Tonga (44 percent), Zimbabwe (43 percent),
Mauritius (41percent), the Republic of the Congo (36 percent), Belize
(34 percent) and Fiji (31 percent). OECD-UNDESA data also high-
light Burundi, Lesotho, Malawi, the Maldives, Mozambique, Namibia,
Niger, Papua New Guinea, the United Republic of Tanzania, and Zambia
as having emigration rates of highly skilled workers more than 20 times
higher than the total emigration rates. Furthermore, migration of tertiary-
educated women is more pronounced than for men, particularly in the
Maldives, the Republic of the Congo, Sierra Leone and Togo.
Asia is a major source for health care professionals in OECD countries. In

2000, 32 percent of doctors and 25 percent of nurses were from Asia, while
the Philippines supplied most of these nurses (OECD 2006). Over the past
ten years, th enumber of migrant doctors and nurses working in OECD has
increased by 60 percent (OECD 2015) Nevertheless, the emigration rate
for health care professionals varies across countries. The Philippines, where
training in health care professions is often a precursor to emigration, the
emigration rate reaches 26 percent for doctors and 47 percent for nurses. In
Malaysia, another traditional origin country, it is 23 percent and 20 percent,
respectively. Asian-born workers also account for more than 6 percent of the
life science and health workers in OECD countries. The figures are higher
for some countries: one in eight workers in life science and health profes-
sional occupations in the United Kingdom and in Australia, and more than
7 percent of the workforce in these professions in Ireland and New Zealand.
Finally, the number of sub-Saharan African-educated physicians migrat-
ing to the United States has increased over 40 percent when compared
to the last decades (Clemens and peterson 2008, Brasher 2013). In most
cases, the countries of origin have paid for the physicians’ training and have
a very low number of physicians relative to the population. These increases
are particularly important because “the number exceeds the total number
of physicians in Ethiopia, Ghana, Liberia, Tanzania, Uganda, Zambia and
Zimbabwe combined” (Tankwanchi et al. 2013).
The Role of Studying Abroad

Studying abroad has become a first step towards emigration while at the
same time the competition to attract and retain students has diversified the
map of destinations. According to the OECD’s Education Indicators in
Focus, 2013/5, between 2000 and 2011, the number of international stu-
dents more than doubled. In 2011, OECD countries were hosting some
77 percent of all students enrolled outside their country of citizenship.
Nevertheless, Australia, the United Kingdom and the United States—
English-speaking countries—together hosted 36 percent of all foreign
tertiary students enrolled worldwide. “In 2006, nearly three quarters of
the world’s tertiary level students were enrolled in developing countries”
(Freeman 2010, p. 394), with Asian students accounting for 53 percent.
Overall, among the OECD countries with available data in 2008 and
2009, the stay rate of international students is up to 25 percent (OECD
2013d). Data from the United States’ National Science Foundation’s
88 F. NAHAVANDI
Survey of Earned Doctorates show 80 percent or more of Asian students

who completed their PhDs in the United States remained in the country
(Altbach 2014). Graduating migrants from Asia account for 17 percent
of all migrants over the age of 15 in OECD countries in the mid-2000s,
and 30 percent of migration inflows in 2010, providing a large part of
skilled migration, with India and China playing an especially important
role (Meyer 2013). Asian migrants are, on average, better educated than
others, and, for some, even more than the natives of OECD countries
(Meyer 2013; UNCTAD 2013).
Taking advantage of the increasing demand for talents, some Global
South countries have now begun to see migration as a way for extracting
benefits for the home society, and have established labor-export agencies
to manage the outflows, control recruitment, train potential migrants,
explore new labor markets, and encourage wealthy countries to employ
their workers, although the precise mix of policies varies from setting to
setting. Others have established financial programs to attract remittances,
while others have negotiated bilateral labor agreements on behalf of their
migrant workers. A few countries provide assistance to migrants seeking
to readjust after a period of work abroad, and some have special programs
to attract back emigrants who have acquired high levels of skill or accu-
mulated significant wealth overseas (Massey 2003). In some cases, flexible
approaches to dual citizenship are adopted in hope that once the emigrant
is back he will invest at home.
Taking into account facts and figures presented above, it can be con-
cluded that overall, trying to outbid their international rivals, many coun-
tries have introduced policy innovations in their immigration programs
as a way to remain in the global race for talent. As was the case for hair
trade, surrogacy and kidney transplant, the international mobility mar-
ket is getting extensively stratified. In this market “membership goods,
including the promise of a ‘green card’ (or ‘blue card’ in the EU) are
subtly turned into instruments for gaining a relative advantage in a com-
petitive inter-jurisdictional scramble for brainpower” (Shachar and Hirschl
2013, p. 100). Although migration and brain drain (Adams 1968) are not
new phenomena, the attraction of brain, a new targeted policy by way of
which the most talented citizens of the Global South are being attracted
to work in wealthier countries, has become a way to view the highly skilled
migrants as resources or assets to compete for, while in the process others
are left behind.
REFERENCES
Adams, W. (Ed) (1968). The brain drain, New York: MacMillan.
Altbach, P. G. (2014, September 4). Why do Indians want to study abroad? The
Hindu. Retrieved January 9, 2015, from http://web.worldbank.org/
WBSITE/EXTERNAL/TOPICS/EXTPOVERTY/EXTPA/0,,contentMDK
:20202198~menuPK:435055~pagePK:148956~piPK:216618~theSit
ePK:430367,00.html
Antecol, H., Coo-Clark, D. A., & Trejo, S. J. (2004). Selective immigration policy
in Australia, Canada and the United States. Brussels Economic Review, 47(1),
45–56.
Bauer, T. K., et al. (2004). The demand for high-skilled workers and immigration
policy. Brussels Economic Review, 47(1), 57–75.
Bedford, R. (2003). New Zealand, the politicization of immigration. The Online
Journal of the Migration Policy Institute. Retrieved December 2, 2014, from
http://www.migrationpolicy.org/article/new-zealand-politicization-
immigration
Bedford, R., Ho, E., & Lidgard, J. (2001). Immigration policy and New Zealand’s
development into the 21st century: Review and speculation. Asian and Pacific
Migration Journal, 10(3–4), 585–616.
Bertoli, S., et al. (2009). The battle for brains: How to attract talent? Non-published
paper. Retrieved November 1, 2014, from http://www.frdb.org/upload/file/
Bruckeretal.pdf
Biao, X. (2007). Global ‘body shopping’, an Indian labor system in the information
technology industry. Princeton and Oxford: Princeton University Press.
Boeri, T., Brücker, H., Docquier, F., & Rapoport, H. (Eds.). (2012). Brain drain
and brain gain, the global competition to attract high-skilled migrants. Oxford:
Oxford University Press.
Borna, S., & Stearns, J. M. (2002). The ethics and efficacy of selling national citi-
zenship. Journal of Business Ethics, 37(2), 193–207.
Brasher, J. (2013). Exodus of physicians to America causing brain drain in Africa.
Research News Vanderbilt. 18 December. Retreived December 15, 2013, from:
http://news.vanderbilt.edu/2013/09/brain-drain/
Bosi, S., Iliopulos, E., & Magris, F. (2008). Skills, immigration and selective poli-
cies. Zagreb International Review of Economics & Business, 11(2), 1–18.
Carr, S., Kerr, I., & Thorn, K. (2005). From global careers to talent flow:
Reinterpreting ‘brain drain’. Journal of World Business, 40, 386–398.
Chaloff, J., & Lemaitre, G. (2009). Managing highly-skilled labour migration: A
comparative analysis of migration policy challenges in OECD countries. OECD
Social, employment and migration working paper 79. Retrieved November 9,
2014, from http://www.oecd.org/els/mig/46656535.pdf
90 F. NAHAVANDI
Clemens, M. and Petterson, G. (2008). New data on African health professionals

abroad. Human Resources for health 2008, 6(1). Retreived December 15,
2013 from: http://www.human-resources-health.com/content/6/1/1
Facchini, G., & Lodigiani, E. (2014). Attracting skilled immigrants: An overview
of recent policy developments in advanced countries. National Institute
Economic Review, 229, R3–R21.
Fassmann, H., & Reeger, U. (2008). Austria: From guest worker migration to a
country of immigration. IDEA Working Papers. Retrieved from http://www.
idea6fp.uw.edu.pl/pliki/WP1_Austria.pdf
Freeman, R. (2010). Globalization of scientific and engineering talent:
International mobility of students, workers, and ideas and the world economy.
Economics of Innovation and New Technology, 19(5), 393–406. 394. Retrieved
January 5, 2014, from 10.1080/10438590903432871.
Green, A. G., & Green, D. A. (1999). The economic goals of Canada’s immigra-
tion policy, past and present. Canadian Public Policy, 25, 425–451.
Hartmann, S., & Langthater, M. (2009). The race for the best: A European perspec-
ofse_eng.pdf
Hawthorne, L. (2005). Picking winners: The recent transformation of Australia’s
skilled migration policy. International Migration Review, 39(3), 663–696.
Hodgson, R., & Poot, J. (2010). New Zealand research on the economic impacts
of immigration 2005–2010, synthesis and research Agenda. Economic Impacts
of Immigration, Working Paper Series. Wellington: Department of Labour.
International Labor Organization. (2014). World of work, developing with jobs.
Retrieved January 16, 2015, from http://ilo.org/global/research/global-
reports/world-of-work/2014/WCMS_243961/lang--en/index.htm
Kahanec, M., & Zimmermann, K. F. (2010). High-skilled immigration policy in
Europe. Bonn: Institute for the Study of Labor. Discussion Paper 5399.
Global Development.
Kerr, W. (2013). U.S. high skilled immigration, innovation and entrepreneurship:
Empirical approaches and evidence. Working paper presented at World
Intellectual Property Organisation (WIPO) Experts Meeting on Intellectual
Property, the International Mobility of Knowledge Workers and the Brain
Drain, Geneva. Retrieved from http://www.people.hbs.edu/wkerr/Kerr_
HighSkillImmEmpirics-8-26-13.pdf
Koslowski, R. (2013). Selective migration policy models and changing realities of
implementation. International Migration, 52(3), 26–39.
Lowell, L. B. (2000). H-1B Temporary Workers: Estimating the population. San
Diego: Center for Comparative Immigration Studies. Working paper no 12.
Macdonald, A. (2013, August 31). Canada seeks immigrants that fit better. Wall
Street Journal.
Mahroum, S. (2001). Europe and the immigration of highly skilled labour.
International Migration, 39(5), 27–43.
Massey, D. S. (2003). Patterns and processes of international migration in the 21st
Century. Paper prepared for Conference on African Migration in Comparative
Perspective. Johannesburg, South Africa. 4–7 June. Retrieved from http://
time.dufe.edu.cn/wencong/africanmigration/1Massey.pdf
Meyer, S. (2013). The brain drain problem: The case of India. Germany: Grin
Verlag.
OECD and UNDESA. (2013). World migration in figures. Retrieved from http://
www.oecd.org/els/mig/World-Migration-in-Figures.pdf
OECD. (2004). International migration outlook 2004. OECD Publishing.
Retrieved December 1, 2014, from http://www.oecd.org/migration/mig/
trendsininternationalmigration2004.htm
OECD. (2006). International migration outlook, 2006, part III, immigrant health
workers in OECD. Retrieved March 2, 2014, from http://www.oecd.org/els/
mig/41515701.pdf
OECD. (2008). The global competition for talent: Mobility of the highly skilled.
Retrieved December 1, 2014, from http://www.oecd.org/sti/inno/
41362303.pdf
OECD. (2012). International migration outlook 2012. Retrieved December
12, 2014, from http://www.npdata.be/BuG/165-NV-A-migratie/0ECD-
Migration-Outlook-2012.pdf
OECD. (2013a). Education indicators in focus, 2013/5. Retrieved December 12,
2014, from http://www.oecd.org/education/skills-beyond-school/EDIF%20
2013--N%C2%B014%20%28eng%29-Final.pdf
OECD. (2013b, June). Economic surveys: New Zealand. Retrieved December 12,
2014, from http://colearnr-media.s3.amazonaws.com/economics/oecd/
New%20Zealand-economic_survey.pdf
OECD. (2013c). International migration outlook 2013. Retrieved January 5,
2014, from www.obela.org/…/International%20Migration%20Outlook%20
2013.pdf
OECD. (2013d). Education indicators in focus. Retrieved January 16, 2015, from
http://www.oecd-ilibrary.org/docserver/download/5k43k8r4k821.pdf?expi
res=1421859781&id=id&accname=guest&checksum=59CB53752B31775C
D2C9C5D521B84512
OECD. (2015). International migration outlook 2015. Changing patterns in the
international migration of doctors and nurses to OECD countries. Retreived
April 19, 2016. From: httpp://www.oecd.org/migration/international-
migration-outlook-1999124X.htm
92 F. NAHAVANDI
Papademetriou, D. G., & Sumption, M. (2011). Rethinking points systems and
employer-selected immigration. Washington, DC: Migration Policy Institute.
Retrieved December 5, 2014, from http://www.migrationpolicy.org/pubs/
rethinking pointssystem.pdf.
Rosewarne, S. (2010). Globalisation and the commodification of labour, tem-
porary labour migration. The Economic and Labour Relations Review, 20(2),
99–110.
Schmidtke, O. (2012). Commodifying migration: Excluding migrants in Europe’s
emerging social model. The British Journal of Sociology, 63(1), 31–38.
Cambridge: Harvard University Press.
Shachar, A. (2011). Picking winners: Olympic citizenship and the global race for
talent. The Yale Law Journal, 120, 2088–2139.
Shachar, A., & Hirschl, R. (2013). Recruiting ‘super talent’: The new world of
selective migration regimes. Indiana Journal of Global Legal Studies, 20(1),
71–107.
Tankwanchi, A. B. S., Özden, C., & Vermund, S. T. (2013). Physician emigra-
tion from sub-Saharan Africa to the United States. Analysis of the 2011
AMA Physician Masterfile. PLOS Medicine 10(9). doi:10.1371/journal.
pmed.1001513
UNCTAD. (2013). The least developed countries report, 2013, growth with employ-
ment for inclusive and sustainable development. Retrieved from http://unctad.
org/en/PublicationsLibrary/ldc2013_en.pdf
United Nations. (2010). World population policies 2009. United Nations
Department of Economic and Social Affairs, Population Division, ST/EAS/
SER.A/293.
Van Riemsdijk, M., & Cook, M. (2013). International talent recruitment to
Norway, opportunities, challenges, and lived experiences of skilled migrants.
Fafo Report.
CHAPTER 7
The Commodification of the Human Body

Parts in a Development-Related Perspective
Abstract Chap. 7 overlays a development-based theoretical discussion on

the processes addressed in previous chapters. Nahavandi contends that the
commodification of the human body is a modern form of well-known his-
torical events such as slavery and colonization, and can be considered as a
new and additional form of appropriation and extraction of resources from
the weakest regions. The author explores and illustrates how these pro-
cesses are fueled by development-related issues of continued poverty and
inequality in the Global South, together with inequality in transnational
relations. The latter, in turn, create new development-related problems,
among which two are particularly addressed: the consequences of access to
healthcare, and the consequences of the attraction of brains.
Keywords Poverty • Inequality • Medical tourism • Brain drain

• Unequal exchange • Economic development • Dualistic system
• Attraction of brains
THE ISSUE
In the previous chapters, transnational hair trade, surrogacy, kidney trans-
plants and the attraction of brains were addressed as different levels and
types of the phenomenon which is today generally known as the com-
modification of human body parts. Today, everything has a price. Hair,

DOI 10.1057/978-1-137-50584-2_7
94 F. NAHAVANDI
wombs and kidneys are paid for with international currency; brains (and
their knowledge) are paid for with points, residency or citizenship. All are
signs of the existing global market with its characteristic law of supply and
demand. The demand for these body parts is mostly coming from wealthier
citizens often living in the Global North or the wealthier states, while the
supply comes often from the Global South. This final chapter overlays a
development-based theoretical discussion on the process addressed previ-
ously. In this framework, the commodification of the human body appears
as a modern form of well-known historical processes. As the embodi-
ment of objectification, it stands in continuity with slavery. As a new type
of extraction of the resources from the Global South, it represents the
continuation of policies and practices characteristic of the colonization
process. Just like slaves who were considered to be commodities, body
parts today are increasingly being considered and treated as commodi-
ties. Similar to the situation during the colonial era, when resources such
as coffee, sugar, oil, diamonds, tin and many others were extracted from
colonized countries to benefit the colonizing ones, today the extraction
of body parts, mostly from the Global South, illustrates a new and addi-
tional form of the appropriation of resources from the weakest regions.
Therefore, it can be argued that although it is not a new phenomenon
in essence, today’s commodification of human body parts, within limits,
however, embodies a modern version of it, grounded in poverty, mostly in
the Global South, and the growing inequality within nations and between
states. In the frame of current transnational relations, this modern version,
beyond all perspectives through which it has already been studied, should
also be considered through a development-related lens that will give the
phenomenon a more complete and informed picture.
COMMODIFICATION OF HUMAN BODY AS DEVELOPMENT-

RELATED ISSUE LINKED TO POVERTY AND INEQUALITY
Poverty and Inequality
Poverty, inequality and the resulting exploitation have always existed.
However, today, more insidious and subtle forms of the exploitation of
poverty, inequalities and disarray are ongoing. It can be assumed that no
Indian woman would give away her hair to temples if she had something
else to offer, and no woman would sell a treasured possession, a part of
herself and her identity, if she could avoid it. In the same way, it is unlikely
THE COMMODIFICATION OF THE HUMAN BODY PARTS IN A DEVELOPMENT … 95
that a rich woman would rent out her womb or a person would sell a kid-
ney if there were no urgency to do so. It is also unlikely that the ‘bright
and brightest’ would leave their country and abandon everything to settle
down elsewhere if they could find a well-paid and fulfilling job in their
homeland. The reasons behind these—sometimes irreversible—decisions
are linked either to poverty in the Global South, and inequality both within
the states constituting it and in transnational relations, or to the incapac-
ity of states to offer some of their citizens what they believe they deserve
when, at the same time, other states are battling to have them, or again to
inequality within transnational relations. Hence, in the process of the com-
modification of the human parts, the potential existence of ‘sellers’, mostly
from developing countries, transforms it into a development-related issue,
even though the latter is expressed differently in the cases of hair trade,
surrogacy, kidney transplants and the attraction of brains. The first three
are facilitated by an individual’s poverty and the last happens because of
the poverty of the states and their weaknesses. Nevertheless, whatever the
form, the four cases are an integral part of the commodification of human
bodies and the extraction of resources from the Global South.
Inequality, both as a concept and a state, is clearly linked to poverty.
The World Bank’s practical and measurable working definition of the lat-
ter is often used: “poverty, defined as whether households or individuals
have enough resources or abilities today to meet their needs” (Coudouel
et al. 2002). The World Bank fixes the absolute poverty line threshold to
$1.25 (PPP) per day and the moderate poverty line threshold to $2 (PPP).
Monitoring poverty usually relies on this income measure. However, pov-
erty is also a relative concept. Two centuries ago, Adam Smith provided its
classic definition: “By necessaries I understand, not only the commodities
which are indispensably necessary for the support of life, but whatever the
custom of the country renders it indecent for creditable people, even of the
lowest order, to be without” (Smith 1776, Book 5, Chap. 3). Moreover,
there is no single correct definition of poverty even though nowadays most
researchers accept that it has to be understood, at least in part, in relation
to particular social, cultural and historical contexts. Peter Townsend con-
cluded that a definition of poverty based solely on income was inadequate.
“Individuals, families and groups in the population can be said to be in
poverty when they lack the resources to obtain the type of diet, participate
in the activities and have the living conditions and the amenities which
are customary, or at least widely encouraged or approved in the societ-
ies to which they belong. Their resources are so seriously below those
96 F. NAHAVANDI
commanded by the average family that they are in effect excluded from
the ordinary living patterns, customs, and activities” (Townsend 1979,
p. 31; 2006). He was criticized for not uncovering poverty, but rather for
illustrating inequality. And, since for many people inequality was inevitable,
his concept of relative poverty was presented as meaningless. Moreover,
his deprivation index, which accompanied the definition, was consid-
ered rather arbitrary in its choice of indicators of poverty. Nonetheless,
Townsend defines poverty in terms of the inability to participate in soci-
ety. In turn, Amartya Sen (1983, 1984, 1985, 1990) offers an alternative
perspective on the role of low income in the definition of poverty and
has contributed to a paradigm shift in the meaning of development away
from economic growth and Growth Domestic Product (GDP) to a focus
on poverty as a denial of choices and opportunities for living a tolerable
life. He acknowledges, among others, strong similarities to Adam Smith’s
analysis of necessities and living conditions, to Karl Marx’s concern with
human freedom and emancipation, and to Paul Streeten’s Basic Needs
approach to development (Streeten 1984). Sen sees income and living
standards as not important in their own right, and emphasizes that what
really matters is the kind of life that a person is able to lead and the choices
and opportunities leading that life. In defining poverty, Sen uses two key
terms: functioning and capabilities. “Functioning is an achievement of a
person: what she or he manages to do or be. It reflects, as it were, a part
of the state of that person” (Sen 1985, p. 10). “Capabilities denote what
a person can do or be, that is, the range of choices that are open to her.
Critical here is the freedom people enjoy to choose between different ways
of living that they can have reason to value” (Sen 1999, p. 114).
Over the last decade, Amartya Sen’s capability approach has emerged
as the leading alternative to standard economic frameworks for thinking
about poverty and inequality. Currently, the human poverty and develop-
ment indices published in the annual UNDP Human Development Report
reflect his approach. Meanwhile, the meaning of poverty has considerably
widened. According to the UN Special Rapporteur on extreme poverty
and human rights, “extreme poverty is a multidimensional phenomenon
that encompasses much more than a lack of sufficient income alone. While
many international actors still use measures based exclusively on income,
such as the World Bank’s $1.25 a day definition, such approaches fail to
capture the depth and complexity of extreme poverty and do not reflect
the significant impact of poverty on the full enjoyment of human rights”
(United Nations Human Rights 2014). In sum, it can be concluded that
today, poverty is widely considered to be a multidimensional problem
and as a complex set of deprivations. It has been refocused as “a human

condition that reflects failures in many dimensions of human life—hunger,
unemployment, homelessness, illness and health care, powerlessness and
victimisation, and social injustice that add up to an assault on human dig-
nity” (Sakiko Fukuda-Parr 2006, p. 7). Nevertheless, Robert Chambers
considers that, to all the abstract categories constructed by development
professionals, the multiplicity of meaning identified by the poor them-
selves should be added (Chambers 2006, 2013).
Inequality is different from poverty, although it is linked to it. It con-
cerns variations and differences in living standards between populations,
while poverty focuses only on those whose standard of living falls below an
appropriate threshold level. Inequality can be defined as “the fundamental
disparity that permits one individual certain material choices, while deny-
ing another individual those very same choices” (Ray 1998, p. 170).
Commodification of the Human Body Parts as a Result of Poverty

and Inequality
The phenomena addressed in this book are linked to both poverty and
inequality. Even though, over time, the position of some countries has
improved, increased inequality is part of today’s reality: a significant num-
ber of people continue to live in sub-human misery, deprived of any form
of opportunities in a world that is richer overall. In the process of the
commodification of the human body, the station of birth matters (Shachar
2009; Deomampo 2013b). Table 7.1 presents data comparing the main
countries of the Global North (‘import’ countries) from those of the
Global South (‘export’ countries) along the general dimensions related to
the issues addressed in this book. Each item illustrates the inequality exist-
ing between the two blocs either in income or in opportunities. Consider
the following: The Gross National Income per capita (GNI/capita) of the
United States is about four times higher than Thailand’s and about twenty
times higher than Bangladesh’s. The poverty headcount at $1.25 a day
(PPP) in percentage of the population of the United States is 1.7 compared
to 43.3 for Bangladesh, about 25 less, and not mentioned for Australia,
Canada and France. Even though the income measure does not reflect the
situation within countries, it shows clearly their overall purchasing power.
Further, the Human Development Index (HDI), “a summary measure of
average achievement in key dimensions of human development: a long and
healthy life, being knowledgeable and have a decent standard of living”
(UNDP 2014), gives a better understanding of the contrasted situation.
Table 7.1 Comparative data on some ‘export’ and ‘import’ countries: income, human development, poverty and
98
inequality
Indicators GNI/per HDI Population Poverty Population in Population Population Gini Gender
capita below head-count at multidi- near in severe coefficient inequality
national $1.25 a day mensional multidi- poverty % index
countries income (PPP) % poverty % mensional
F. NAHAVANDI
poverty line populationa poverty %
United 52,308 0.914 … 1.7 (2010) … … … 40.8 0.262

States
Canada 41,887 0.902 … … … … … 32.6 0.136
Australia 41,524 0.933 … … … … … 34a 0.113
France 36,629 0.884 … … … … … 31.7a 0.080
United 35,002 0.892 … 1.0 (2010) … … … 36.0 0.193
Kingdom
Thailand 13,364 0.722 13.2 0.3 (2010) 1.01 4.4 0.1 39.4 0.364
China 11,477 0.719 11.8 6.3 (2011) 5.98 19 1.3 42.06 0.202
Egypt 10,400 0.682 25.2 … 8.93 8.6 1.5 30.8 0.580
Indonesia 8970 0.684 12 16.2 (2011) 5.9 8.1 1.1 38.1 0.500
Philippines 6381 0.660 26.5 19.0 (2012) 7.26 12.2 5.0 43.0 0.406
India 5150 0.586 12 23.6 (2012) 55.28 18.2 27.8 33.9 0.563
Vietnam 4892 0.638 20.7 2.4 (2012) 6.45 12.2 2.1 35.6 0.322
Pakistan 4652 0.537 22.3 12.7 (2012) 45.59 13.2 21.7 30.0 0.563
Bangladesh 2713 0.558 31.51 43.3 (2010) 49.56 18.8 21.0 32.1 0.529
Source: Available data selected in Human Development Report 2014 and World Bank Data base
a
World Bank Data Base
Gross national income/per capita (GNI/per capita): Aggregate income of an economy generated by its production and its ownership of factors of produc-
tion, less the incomes paid for the use of factors of production owned by the rest of the world, converted to international dollars using PPP rates, divided by
midyear population
Human Development Index (HDI): A composite index measuring average achievement in three basic dimensions of human development: a long and healthy
life, knowledge and a decent standard of living
Population below national poverty line: Percentage of the population living below the national poverty line, which is the poverty line deemed appropriate for
a country by its authorities. National estimates are based on population-weighted subgroup estimates from household surveys
Population in multidimensional poverty: Percentage of the population that is multidimensionally poor adjusted by the intensity of the deprivations
Population near multidimensional poverty: Percentage of the population at risk of suffering multiple deprivations—that is, those with a deprivation score of
20 to 33 percent
Population in severe multidimensional poverty: Percentage of the population in severe multidimensional poverty—that is, those with a deprivation score of
50 percent or more
Gini coefficient: Measure of the deviation of the distribution of income among individuals or households within a country from a perfectly equal distribution.
A value of 0 represents absolute equality, a value of 100 represents absolute inequality
Gender inequality index: A composite measure reflecting inequality in achievement between women and men in three dimensions: reproductive health,
empowerment and the labor market
Source: Definition of items selected in UNDP Reports
THE COMMODIFICATION OF THE HUMAN BODY PARTS IN A DEVELOPMENT …
99
100 F. NAHAVANDI
Though to some extent HDI is linked to GNI, there is no automatic

causality. However, obviously the HDI of ‘exporting’ countries, usually
belonging to Medium or Low Human Development category, except for
Thailand, is lower than that of the importing ones, which all belong to
the Very High Human Development category. Focusing on poverty and
its inequality indicators is edifying. The provider countries, as shown in
Table 7.1, are characterized by statistically significant percentages of pov-
erty reflected by high levels of population below national income poverty
line (from 11.8 to 31.51), population in multinational poverty (1.01 to
55.28), population near multinational poverty (from 4.4 to 18.8) and
population in severe poverty (from 0.1 to 27.8).
It can be noticed that poverty figures are especially high in South
Asia. According to the 2014 Human Development Report, South Asia
has more than 800 million poor and over 270 million near-poor—that
is, more than 71 percent of its population (UNDP 2014). Meanwhile,
Table 7.1 illustrates that for all ‘exporting’ countries, inequality, as mea-
sured by the Gini Index, is above 0.30 with a significant high score for
China and the Philippines, and that gender inequalities are higher in
South Asia and Egypt. Indeed, income inequality is growing in the Asia-
Pacific region. In that frame, the two colossuses of Asia, China (1.385
billion people) and India (1.252 billion people), together with Indonesia
(249 million people), show the same trend. Some 49,000 people own
30 % of the total wealth there. In those three countries, economic growth
seems to have benefited the affluent class more than those who are poor.
In turn, “The disparity has also been rising horizontally. Urban and coastal
regions are getting richer much faster. Weaker labor market institutions,
inadequate social protection systems, poor-quality education, inadequate
access to credit and land as well as excessive asset concentration are among
the factors for widening income gaps. This growing disparity could trig-
ger social and political instability. Multi-racial countries with significant
regional variations are most vulnerable” (Sethi 2014).
The Gender Inequality Index within the ‘exporting countries’ is also
high. Gender inequality is particularly high in South Asia, Indonesia and
Egypt. For example in Pakistan, where half of the population lives in pov-
erty, only 19.3 percent of adult women have access to a secondary level of
education compared to 46.1 percent of their male counterparts. For every
100,000 live births, 260.0 women die from pregnancy-related causes;
the adolescent’s birth rate is 27.3 births per 1000 live births (Haider
2014); and the percentage of female labor force participation is 24.4. In
comparison, in Bangladesh the maternal mortality rate is 240, the adoles-

cent birth rate is 80.589, the percentage of female population with at least
a secondary education is 30.8 and the percentage of female labor force
participation is 57.3. In India, respectively the figures are 200, 32.799,
26.6, and 28.8. The situation for women is considerably worse than it
is for men, a fact that is important considering that gender inequality is
a main component of the Global South and an important dimension of
the commodification of human body parts, as far as the discrimination of
women compared to men intersects with other dimensions such as ethnic-
ity, religion, age and power relationship.
The 2014 Human Development Report states that high inequal-
ity between groups is not only unjust but can also affect wellbeing and
threaten political stability. It can be added that poverty and high inequality
also fuel the commodification of the human body and the selling of body
parts. The situation of the hair donors and sellers, the gestational carriers
and the kidney sellers addressed in previous chapters unambiguously illus-
trates that they mostly issue from disempowered populations, with women
and men striving for survival in increasingly hostile surroundings. Their
motivations to sell a part of their body, even though sometimes hidden
by altruist discourses, are clearly, as shown in all case studies addressed,
grounded in poverty, disarray and inequality. Therefore, some dimensions
highlighted by Scheper-Hughes for transplant trade can be generalized
(2013): “In general, sellers include poor nationals, new immigrants, global
guest workers, or political and economic refugees recruited from abroad to
serve the needs of transplant tourists in countries that tolerate or actively
facilitate the illegal transplant trade”. The poor are excluded from econo-
mies, societies and polities, or included in them only on adverse terms
(Chronic Poverty Advisory Network 2014). According to the experts of
Chronic Poverty Advisory Network (CPAN), who define chronic poverty
“as extreme poverty that persists over years or a lifetime, and that is often
transmitted intergenerationally” (CPAN 2014, p. 4), ‘adverse inclusion’
is a term better fitted to the circumstances of chronically poor people in
developing countries than the term used more frequently, ‘social exclu-
sion’. “The terms of poor people’s inclusion in the economy, politics and
culture are adverse in that they produce negative results for those people,
and are underpinned by unequal and sometimes exploitative power rela-
tions. Adverse inclusion has economic, political, socio-cultural and spatial
dimensions” (CPAN 2014, p. 22).
102 F. NAHAVANDI
It seems obvious that overcoming poverty, especially in its chronic and

severe form in the Global South, as well as adverse inclusion will partly
resolve some questions linked to the commodification of the human body.
The latter is related to the existing market. And, as in any market, the issue
of supply and demand is essential. If there are at least no more poverty-
motivated suppliers in the Global South, the process of commodification
of human body will appear in a different light and based on other grounds.
Today, the hair, wombs, kidneys and brains of people who believe they
have no other choice, and indeed may not have any other choice, supply
the human body parts market. If the motivations of ‘sellers’ are taken into
account the argument gets even more acute. The acts of selling hair and
kidneys or renting out wombs have been mostly explained by factors that
are taken for granted elsewhere. Mostly, having a roof, sending children to
school, marrying one’s children, nursing one’s family member, and help-
ing a husband, a wife or an older parent, have been expressed, as well as, to
a lesser degree, one’s own consumption. People may not always be aware
of the consequences of their actions, but even if they are, those conse-
quences may not be sufficient to stop them, since the consequences of not
engaging in such transactions may seem worse to them. Consider the case
of the children. The UN data highlights that one in five children in devel-
oping countries live in absolute poverty. “In developing countries 7 in
100 will not survive beyond 5, 50 will not have their birth registered, 68
will not receive early childhood education, 17 will never enroll in primary
school, 30 will have stunted growth and 25 will live in poverty” (UNDP
2014). Children’s situation has been expressed as a motivation by body
part sellers. If we consider the motivations, basic needs are important.
Having access to what one deserves as a human being is evident. That
is why the commodification of the human body is also a development-
related issue. For some of the sellers, selling a part of their body appears
to be the only way to have access to public goods. Meanwhile, the voices
of sellers also reveal complex histories of people struggling to get into a
global market on the best terms they can master (Deomampo 2013a, b).
Although sellers can be portrayed as powerless or as simple commodities
or raw materials, some agency in the context of constrained opportunity
can also be acknowledged, rendering even more complex understand-
ings of the situations. The poor face intersecting inequalities, and poor
women face even more. Moreover, the global processes portrayed in the
case studies reproduce stratification at local, community and transnational
levels, creating a new range of actors whose agency depends on limiting
that of others, brokers and global consumers. In that sense, transnational
flows of capital, technology and bodies signal how the commodification of

human bodies reifies and reinforces global inequities and new circulations
of resources. The process brings opportunities for some people while it
maintains or worsen conditions for others. Lack of education and social
capital and differences in class status and gender between actors involved
in the process fuel the unequal exchange.
In turn, if we consider the attraction of brains phenomenon, it can
also be highlighted that the overall income and power of importing states
make a difference. Table 7.2 presents data comparing the main regions
Table 7.2 Comparative data on some ‘export’ and ‘import’ regions and coun-
tries: emigration rate of tertiary educated (% of total tertiary educated
population)
Indicators Emigration rate Emigration rate
1990 2000
Countries and regions
Caribbean small states 79.8 78.8
Heavily indebted poor countries 18.5 20
Sub-Saharan (all levels of income) 13.2 12.5
Low income countries 11.3 12.4
Least developed countries 11.4 12.3
Latin America (all levels of income) 10.1 11
Latin America (developing only) 9.7 10.8
Middle East & North Africa (developing 13.4 10.4
only)
Middle East & North Africa (all income 11.3 9.2
levels)
European Union 9 9
Low & middle income 7.1 7.8
Middle income 6.9 7.6
Upper middle income 7.2 7.4
East Asia & Pacific (developing only) 6.87 7
Europe & Central Asia (all income levels) 6.7 6.8
East Asia & Pacific (all income level) 5.42 5.8
Europe & Central Asia (developing only) 5 5.6
OECD Members 4.1 4.1
India 2.8 4.3
High income OECD 3.8 3.7
China 3 3.7
High income non OECD 3.8 3.7
North America 0.99 0.89
Source: World Bank Data

104 F. NAHAVANDI
of the Global North (‘import’ countries) from those of the Global South
(‘export’ countries) in terms of the emigration of the highly skilled. Each
item illustrates the inequality existing between the two blocs. As presented
in 2000, the emigration rate from North America of those with a tertiary
education is 0.89, whereas the rate from small Caribbean states amounts
to 78.8. It can also be highlighted that low-income regions have a higher
rate of emigration among their highly skilled citizens. The trend is linked
to the job opportunities and possibilities offered by the states to this cat-
egory. The needs and aspirations of the most educated are not satisfied.
The political situation also may explain the brain drain. Whatever the
reason, the regions that most need the know-how are the most affected
by the departure of highly skilled people. Comparatively, the emigration
rate from Europe and Central Asia may seem high. It illustrates that the
phenomenon also exists within high-income countries, and indeed it is
considered worrisome to European authorities. Finally, even though the
emigration rate of the those with a tertiary education is low in countries
like China and India, as already addressed in Chap. 6, the total number of
Chinese and Indian nationals migrating to the Global North is increasing.
However, the number of graduates in populous countries more than com-
pensates for the increase in the outflow of highly skilled migrants, whereas
the latter is more acute in countries with small populations and island
states. The inequalities between regions and consequently their attractive-
ness are also due to factors that intersect with income and power. Such is
the case of the investments made in R&D, as addressed in Table 7.3. In
2014, ten countries spent 80 percent of the total $1.6 trillion invested in
R&D around the world. The combined investments by the United States,
China and Japan accounted for more than half the total, and if Europe is
added they accounted for 78 percent (Grueber et al. 2014). The United
States is still the world’s largest investor, while all data on the growth of
Table 7.3 Global R&D funding as percentage of GDP

Indicator R&D investments as percentage of GDP
Region
Americas 2.5
Asia 1.9
Europe 1.8
Rest of the world 0.9
Source: Grueber et al. (2014)

R&D budgets show that, soon, China will outpace the former. Therefore,
the international imbalance in power and capacities between countries
has left space for discrepancies between regions favoring transnational
inequalities and fueling the migration of the best and brightest.
COMMODIFICATION OF THE HUMAN BODY PARTS

AS A SOURCE OF DEVELOPMENT ISSUES
Taking into consideration the facts and figures highlighted in the above
section, it can be concluded that poverty and inequality in the Global
South fuel the process of commodification of the human body. However,
the latter also creates or worsens development-related issues. They are
manifold. Considering the cases addressed in this book, two are particu-
larly striking: the consequences on access to healthcare and the conse-
quences of the attraction of brains.
The Inequality in Access to Healthcare

Organ transplantation and transnational reproductive care have today
become part of what is called ‘medical travel’. In the framework of today’s
neoliberal policies, which require governments to open their markets to
global trade and encourage treating medical services as an export industry
capable of promoting local development for many of the Global South’s
governments, promoting ‘medical travel’ is increasingly becoming a new
source of economic development per se, and an opportunity to secure for-
eign exchange, while health care is framed as a tradeable commodity. This
puts constraints on a government’s ability to maintain social spending,
notably, but not exclusively, in public health. Indeed, capitalizing on the
comparative cost advantages permitted by their domestic health facilities,
some developing countries are aiming to supply ‘services’ to patients of
foreign origins or to their wealthy diaspora, to people who can afford it.
These services are seen as exports (Godwin 2004; Pfeffer 2011; Whittaker
and Speir 2010; Whittaker 2011). What can be considered a growing
industry for some countries, which have both the human capacities and
the technologies necessary, can be compared to some previous strategies
of industrialization and their consequences, among others, to the import
substitution strategy (ISI) and to the export-oriented strategy. The for-
mer emerged as a way to increase self-sufficiency and decrease dependency
106 F. NAHAVANDI
on developed countries, meanwhile saving hard currencies. It focused on

the protection and incubation of domestic infant industries so they could
emerge to compete with imported goods. Although the strategy was suc-
cessful in many ways, one of the remaining problems was the limited size
of the national market. It led some governments to switch to the export-
oriented strategy, which became a key success, particularly for Asian Tigers,
as a strategy based on the existence of comparative advantages in order to
enter the global market and outbid competition, and which consisted on
subsidies on the production of exportable output.
Nonetheless, a major difference between ISI and ‘medical tourism’ is
that in the latter, an awareness of the small number of domestic consum-
ers has from the start made it open to foreign patients, whereas in ISI the
domestic market was considered together with the global market. One of
the weaknesses of ISI has been that the domestic market could not sup-
port the strategy because of the poverty or the limited financial resources
of the local consumers, which is the case for many locals in the ‘medi-
cal travel’ strategy. The other weakness was the lack of human capital,
which obviously is not the case for ‘medical tourism’. In turn, the latter
was based on attracting exchange and foreign consumers from the start, a
characteristic shared with the export-oriented strategy.
The backbone of ‘medical travel’ is the same as that of ISI or that of
the export-oriented industrialization strategy. Governments support the
strategy by encouraging the development of the infrastructure for medical
travel, through fiscal policies and many incentives and subsidies offered
to the corporate medical institutions together with land deals and public-
private partnership. These medical institutions have become hubs of the
trade. In that framework, a loose regulatory regime and lack of regulations
have become a ‘market advantage’ and the bioavailability of populations
and potential donors/sellers a ‘resource of trade’.
The implications of the choice of a ‘medical travel’ promotion strategy
on the equity of national health systems can be worrisome in many regards.
Among other concerns, there is the quality of and access to services, espe-
cially in a time period when international financial institutions such as
the International Monetary Fund (IMF) or the World Bank are requiring
them to curtail or eliminate subsidized or free basic health care facilities,
and to impose users fee, introduce private insurance and allow market
forces to determine medical prices (Pfeffer 2011). ‘Medical travel’ promo-
tion diverts resources and personnel towards those able to mobilize the
financial resources to travel. Moreover, the prices and costs of treatment
in corporate hospitals are unaffordable to the majority and have trickle-

down effects on all prices in the market. The poor and middle-income
populations are often not covered by any private insurance that can give
them access to high-tech care, or even ordinary care. Some poor house-
holds have no cash whatsoever at many points of the year, for example
just before harvest. “It has been estimated that a high proportion of the
world’s 1.3 billion poor have no access to health services simply because
they cannot afford to pay at the time they need them. They risk being
pushed into poverty, or further into poverty, because they are too ill to
work […] In some countries, up to 11% of people suffer this type of severe
financial hardship each year and up to 5% are forced into poverty because
they must pay for health services at the time they receive them. Recent
studies show that these out-of-pocket health payments pushed 100,000
households in both Kenya and Senegal below the poverty line in a single
year. About 290,000 experienced the same fate in South Africa” (WHO
2010). ‘Medical travel’ weakens public health systems as the urban-centric
corporate hospitals draw away the best-qualified personnel from the public
sector by offering higher salaries and better working conditions (Godwin
2004). The process that adds to the migration of physicians and health
workers, addressed further, is dramatic for some countries, in which rural
areas have their health options ‘harvested’. For example, in India, 80 per-
cent of physicians, 75 percent of health centers and 60 percent of hospitals
are situated in urban areas (Hazarika 2013) where only 32 percent of the
population lives. Furthermore, the emphasis on capital-intensive medical
technologies, which characterize the new medical travel strategy, changes
the perception about what a health system, good care and even disease
can be, as many medical schools in source nations are influenced by the
‘western aspirations’ of their students. As a result, their training programs
are not well aligned with local patterns of disease and levels of technology
(Mullan 2005). Medical travel is imposing a specific biomedical model on
the Global South that may undermine culturally specific approaches to
healing and wellness (Saniotis 2007).
Nowadays, in many countries a dualistic system has emerged, character-
ized by a technological advanced and excellent treatment system open to
foreigners and local elites and a public health system that is getting weaker
and cannot respond to the demands of large groups of population unable
to fulfill their basic needs. In its time, the dualistic economic scheme result-
ing from the ISI strategy has been largely commented and criticized too.
Indeed, the latter led to the creation of two sectors, one modern, techni-
108 F. NAHAVANDI
cally advanced and capital intensive and the other poor, technically primi-
tive and self-sufficient, a reality that accentuated the inequality between
the rich and poor. “In 2001, the WHO called for innovative approaches,
such as the development of low-cost treatments and technology for low-
resources settings. Yet, even as these strategies are being implemented, a
number of developing countries are involved in the global trade in assisted
reproductive care, while their local population still struggle to afford these
technologies” (Whittaker 2011, p. 110). It can be hoped that a universal
health coverage system, which is promoted by international institutions,
can try to overcome the fundamental inequality and inequity between the
haves and have-nots, at least in terms of access to health. It already seems
as if Thailand, a hub for medical travel, has succeeded in improving health
care at a low cost by financing health reforms to ensure equitable access
to care. For the time being, the inequity and injustice of focusing on pro-
viding medical care to well-off foreign patients, when the people living
below the poverty line have no access to basic health care, and when the
resources devoted to providing medical care to patients from outside of
a country undermine the country’s ability to provide the same services
for its own population, can still be highlighted in many cases. Therefore,
the increased movement of patients from high-income countries seeking
services in low-income countries exacerbates the potential exploitation of
economically vulnerable groups involved in this trade (Whittaker 2010).
Consequences of the Attraction of Brains and the Brain Drain

In turn, attracting brains can also have severe implications for the Global
South. Consider the following. In recent years, the United States, the
United Kingdom, Canada and Australia have been the beneficiaries of the
large-scale immigration of physicians, creating concerns about the disparity
in the availability of physicians from country to country and the negative
impact of the scarcity of physicians on health equity (Mullan 2005). The
Indian subcontinent provides the largest absolute number of physicians
to the recipient nations; however, the relative draw on countries, as mea-
sured by the emigration factor, is actually greater for sub-Saharan Africa
and very dramatic in Caribbean countries. According to the International
Organization for Migration, the continent lost 60,000 professionals (doc-
tors, university lecturers, engineers, etc.) between 1985 and 1990, and
has been losing 20,000 professionals each year since 1990. This trend has
sparked claims that the continent is dying a slow death from brain drain,
and has led to a belated recognition by the United Nations that “emigra-
tion of African professionals to the West is one of the greatest obstacles to
Africa’s development.”
The situation of the ‘brain sellers’ is not always related to poverty.
Those who emigrate may not be poor and may belong to the privileged
category of highly educated not only in their country but also in the
world. At the same time, improving their family situation or overcoming a
temporary crisis may motivate them. However, they clearly also belong to
states that cannot provide the levels of employment and salaries offered by
wealthier countries, and sometimes to states impoverished by neoliberal
impositions as part of bailout packages. Even though the phenomenon of
‘selling brain’ also exists within high-income countries, it is significantly
broader in frame of South-North relations. Moreover, its consequences, as
will be discussed further, are more severe. Indeed, the process traditionally
named ‘brain drain’ generally refers to the permanent or long-term inter-
national emigration of skilled people who have been subject of consider-
able educational investment by their own societies. As mentioned before,
the migration of highly skilled individuals is both growing and encour-
aged by high-income countries. Economic globalization has brought an
increasing demand for highly trained human capital in advanced devel-
oped countries, and has removed mobility barriers for high-trained human
capital. This trend can be a serious loss for the source country.
Recently, the general definition of brain drain has become more
refined. “Two conditions are necessary for the term brain drain to apply
to a given country. First, there must be a significant loss of the highly edu-
cated population. Second, adverse economic consequences must follow”
(Lowell 2013). Many reports emphasize the advantages of brain drain
for the donor country by highlighting the benefit from the transfer of
remittances and skills gained abroad. At the same time, they also argue
that negative effects are difficult to point out while deploring the loss of
homegrown talent. Nevertheless, the increasing number of reports detail-
ing how to deal with brain drain and the multiplying of recommenda-
tions regarding the issue demonstrate that it cannot be ignored and that
overall it is considered as a problem. It is the case of two well-known
and often-cited reports issued by the World Bank and International Labor
Office (Docquier and Rapoport 2008; Lowell and Findlay 2002). The
gains from money sent back home (remittances) or from expatriates com-
ing back later in their careers, and the educational links that they establish,
may be of some benefit and considered as brain gains. However, it is hard
110 F. NAHAVANDI
to imagine how these would replace or be more useful than doctors,

nurses, teachers staying in places where they are badly needed, as there
can be little question that the emigration of physicians is also a loss to the
health systems of the source countries. “The effect of the emigration of
physicians, many of whom come from poor countries, varies from nation
to nation, but there are always costs to the source country in terms of
financial resources (investment in education) and human capital (gifted,
ambitious people)” (Mullan 2005). For example, “it costs $ 40,000 to
train a doctor in Kenya, and $15,000 for a university student” (Tebeje
2005). The United Kingdom, (2.77 physicians/1000 population and 3
beds/1000 population) Canada, (2.07 physicians/1000 population and
3.2 beds/1000 population) and Australia (3.85 physicians/1000 popula-
tion and 3.9 beds/1000 population) draw substantially from South Africa,
(0.76 physicians/1000 population and 2.8 beds/1000 population) and
the United States draws very heavily from the Philippines. While there
are 1.15 physicians/1000 population in the Philippines and 1 bed/1000
population, there are 2.42 physicians/1000 population and 3-beds/1000
population in the USA (Central Intelligence Agency 2014). It entails the
transfer of scarce human resources for health from the least developed
countries in the world with the greatest health needs to the richest coun-
tries with the most health resources (Brasher 2013).
The trend of sub-Saharan African physicians’ migration to the United
States has increased over 40 percent when compared to the last decades.
In most cases the countries of origin have paid for the physicians’ train-
ing and have a very low number of physicians relative to the population.
Emigration from Africa began in the mid-1980s following structural
adjustments imposed by international financial institutions and the pub-
lic sector budget cuts included into the bailout packages. Inevitably, the
emigration of physicians from low- and middle-income countries under-
mines health service delivery in the emigrating physicians’ country of ori-
gin because physician supply is already inadequate. Physician emigration
from sub-Saharan Africa, which has only two percent of the global phy-
sician workforce but a quarter of the global burden of disease, is par-
ticularly worrisome. Since 1970, as a result of large-scale emigration and
limited medical education, there has been negligible or negative growth
in the density of physicians in many countries in sub-Saharan Africa. In
Liberia, for example, in 1973, there were 7.76 physicians per 100,000
people, but by 2008 there were only 1.37 physicians per 100,000 people
(Tankwanchi et al. 2013). Some industrial countries offer health service
provisions to developing countries, which can be rather inadequate. For

example, in 2004, it is estimated that Ghana lost around $45 million of its
training investment in health professionals to the United Kingdom, while
the later saved about $98 million in training costs by recruiting Ghanaian
doctors, which clearly outstripped the provision of an estimated $55 mil-
lion by the United Kingdom to Ghana (Hartmann and Longthater 2009,
p. 14). In migration flows of the highly qualified, asymmetries are clearly
visible. Tanzania and Gambia experienced, respectively, a 59 percent and
83 percent proportionate loss of physician coverage between the early
1970s and mid-2010s. 65,000 African-born physicians and nearly 70,000
African-born professional nurses were practicing in eight Organization of
Economic Cooperation and Development (OECD) high-income coun-
tries and in South Africa (Clemens and Pettersson 2008). Sub-Saharan
Africa harbors about fourteen percent of the world’s population, but has
only three percent of the world’s health professionals, of whom 17.5 per-
cent had emigrated by 2005 (WHO 2006). The number of physicians for
every 1000 in the population is barely 0.11 in the Democratic Republic
of Congo (CIA 2014). The paradox is that, at the same time, to fill the
gap created by skills shortage, African countries spend an estimated $4
billion annually to employ about 100,000 non-African expatriates. The
international experts claim that human capital should be strengthened in
developing countries. However, in today’s order, it also paradoxically can
lead to the emigration of the human capital.
Docquier and Rapoport (2008) have factored many externalities for
developing countries: “skilled migrants are net contributors to the govern-
ment budget and their departure, therefore, increases the burden on those
left behind, skilled labor and unskilled labor complement one another in
the production process; in a context of scarcity of skilled labor and abun-
dant unskilled labor, as is the case in developing countries, skilled labor
migration may have a substantial negative impact on low-skilled workers’
productivity and wages (intra-generational spillover) and increase domes-
tic inequality. Third, human capital depletion through emigration would
seem to impact negatively on a country’s growth prospects, inasmuch
as human capital formation is now viewed as a central engine of growth
(intergenerational spillover). Fourth, as demonstrated in various new eco-
nomic geography frameworks, skilled labor is instrumental in attracting
FDI and fostering R&D expenditures (technological externality); hence,
the mobility of human capital is contributing to the concentration of eco-
nomic activities in specific locations, at the expense of origin regions.”
112 F. NAHAVANDI
It is noted that high-skilled immigrants promote knowledge flows

and foreign direct investments to their home countries. It is still unclear
whether this benefit fully compensates the country for the potential nega-
tive consequences from the talent migration (Kerr 2013). A study from the
Arab League highlights that the emigration of intellectuals from the Arab
world accounts for about one-third of the total brain drain from develop-
ing countries to the West. Arab countries lose half of their newly qualified
medical doctors, 23 percent of their engineers and fifteen percent of their
scientists each year, with three quarters of them moving to the United
Kingdom, the United States and Canada. This is estimated to equate to
annual losses to Arab states of more than $2 billion. Moreover, 45 percent
of Arab students who study abroad do not go back to their countries after
graduating. Seventy thousand college graduates immigrate to Western
countries every year. This number is almost equal to a quarter of all col-
lege graduates (Fakouri 2008, 2012). An IMF study highlights that Iran
ranks highly in the brain drain, with about 150,000 to 180,000 graduates
leaving the country each year (Carrington and Detragiache 2006). One
of four graduated Iranian students emigrates. Many have received attrac-
tive offers to study in the United States and in Canada (CEOOR, no
date). “According to a 2012 survey by the Arlington, Va.-based National
Science Foundation, 89 percent of Iranian doctoral students remain in the
U.S. after graduation—equal to the Chinese and the highest percentage of
nationalities surveyed” (Mottevali 2014). In turn, according to estimates
of the Iranian Ministry of Science, Research and Technology, the brain
drain loss amounts to more than $40 billion a year, a sum nearly equiva-
lent to the oil revenues in the beginning of the 2000s.
Finally, “aggregate losses of human capital conceal substantial sector-
specific effects” (Kapur and McHale 2005, p. 102). If the consequences
of the migration of health workers have been extensively addressed, the
consequences of the migration of education specialists are less studied.
In this respect, Kapur and McHale (2005, p. 104) state the exporter of
human capital could face a decline in the quality of its human capital over
time. Indeed, in the education sector, the problems and long-term conse-
quences appear worrying. “Where a market is no longer confined within
national boundaries, innumerable college teachers in developing countries
with the requisite human capital are willing to work in high schools in
developed countries, or, in fact, in any other profession, so long as they
leave. As developed countries use selective screening tools, a vicious cycle
ensues, in which individuals at the upper end of the human capital distri-
bution emigrate and leave behind a pool of poorer quality. This not only
prompts others at the higher end to also consider leaving but also discour-
ages anyone who has left in the past from returning home, thereby ensur-
ing that mediocrity becomes entrenched in these institutions” (Kapur and
McHale 2005, p. 104). The same reasoning applies to research in devel-
oping countries, where the productivity of researchers is much weaker
and where, as for the health sector, the private sector becomes the only
way out. Indeed, as in private corporate hospitals, the salaries are higher
and the working conditions much better. Here also, it leads to a dualistic
situation with a dynamic private sector often concentrated on maximizing
profits and a public sector of poor quality opened to the majority.
To conclude this chapter, it can clearly be stated that the commodifica-
tion of human body parts, apart from all the issues usually addressed by
scholars and professionals, has a development-related dimension that can-
not be overlooked. Commodification introduces a vicious cycle through
which development-related issues engender commodification, which in
turn deepens or creates development-related issues. Finally, there is a fun-
damental inconsistency in the international development discourses that
emphasize development and, at the same time, overlook the consequences
of the market solutions imposed. This is an inconsistency that can also
apply to discourses addressing the commodification of the human body,
which does not take into consideration the contextual dimension and the
station of the sellers.
REFERENCES
Brasher, J. (2013, December 18). Exodus of physicians to America causing brain
drain in Africa. Research News Vanderbilt. Retrieved December 15, 2013, from
http://news.vanderbilt.edu/2013/09/brain-drain/
Carrington, W. J., & Detragiache, E. (2006). How big is the brain drain? IMF,
Working Papers Series. 98/102. Retrieved January 16, 2015, from http://
papers.ssrn.com/sol3/papers.cfm?abstract_id=882624
Central Intelligence Agency. (2014). The world factbook. Retrieved from https://
www.cia.gov/library/publications/the-world-factbook/geos/as.html
Chambers, R. (2006). What is poverty? Who asks? Who answers? In Poverty in
focus (pp. 3–4). Geneva: UNDP. Retrieved January 5, 2015, from http://
www.ipcundp.org/pub/IPCPovertyInFocus9.pdf
Chambers, R. (2013). Rural development, putting the last first. New York. First
Published in 1983.
114 F. NAHAVANDI
Chronic Poverty Advisory Network. (2014). The chronic poverty report, 2014–
2015. Retrieved January 10, 2015, from http://www.odi.org/sites/odi.org.
uk/files/odi-assets/publications-opinion-files/8834.pdf
Clemens, M., & Pettersson, G. (2008). New data on African health professionals
abroad. Human Resources for Health. 6(1). Retrieved December 15, 2013,
from http://www.human-resources-health.com/content/6/1/1
Coudouel, A., et al. (2002). Poverty measurements and analysis. Retrieved from
http://siteresources.worldbank.org/INTPRS1/Resources/383606-
1205334112622/5467_chap1.pdf
Deomampo, D. (2013a). Transnational surrogacy in India. Frontiers, 34(3),
167–188.
Deomampo, D. (2013b). Gendered geographies of reproductive tourism. Gender
& Society, 27(4), 514–537.
Docquier, F., & Rapoport, H. (2008). Skilled migration, the perspective for devel-
oping countries. World Bank Policy Research Paper no 3382, 2007. Retrieved
January 13, 2015, from http://web.mit.edu/is08/pdf/rapoport.pdf
Fakouri, H. (2008). The brain drain in the Arab world. Report from the Arab
league. The Middle East. 9. Retrieved October 1, 2013, from http://mid-east-
today.blogspot.be/2009/11/brain-drain-in-arab-world.html
Fakouri, H. (2012). Emigration from the Arab and sub-saharan regions: A socio-
political inquiry into push factors, policies and diasporas contributions to develop-
ment. Research report 12. Migration Policy Center. San Domenico Di Firenze.
Retrieved January 18, 2015, from http://www.migrationpolicycentre.eu/
docs/MPC%202012%2012.pdf
Godwin, S. K. (2004, September 4). Medical tourism: Subsidizing the rich.
Economic and Political Weekly.
Grueber, M., Studt, T., et al. (2014). 2014 global R&D funding forecast.
BATELLE. Retrieved August 2, 2015, from http://www.battelle.org/docs/
tpp/2014_global_rd_funding_forecast.pdf
Haider, M. (2014, September 20). Half of Pakistan population lives in poverty:
UN report. The News. Retrieved December 1, 2014, from http://www.the-
news.com.pk/Todays-News-2-273911-Half-of-Pakistan-population-
lives-in-poverty-UN-report
Hartmann, S., & Longthater, M. (2009). The race for the best: A European perspec-
ofse_eng.pdf
Hazarika, I. (2013). Health workforce in India: Assessment of availability, produc-
tion and distribution. WHO South Asia Journal of Public Health, 2(2),
106–112.
Global Development.
Kerr, W. (2013). U.S. high skilled immigration, innovation and entrepreneurship:

Empirical approaches and evidence. Working paper presented at World
Intellectual Property Organisation (WIPO) Experts Meeting on Intellectual
Property, the International Mobility of Knowledge Workers and the Brain
Drain, Geneva. Retrieved from http://www.people.hbs.edu/wkerr/Kerr_
HighSkillImmEmpirics-8-26-13.pdf
Lowell, L. B. (2013, June). Skilled migration abroad or human capital flight?
Migration Information Source. Retrieved January 8, 2014, from http://www.
migrationinformation.org/USfocus/display.cfm?ID=135
Lowell, L. B., & Findlay, A. (2002). Migration of highly skilled persons from devel-
oping countries: Impact and policy responses. A Project Report for the
International Labor Office and the United Kingdom’s Department for
International Development. Geneva: ILO. Retrieved January 8, 2014, from
http://www.ilo.org/public/english/protection/migrant/publ/imp-list.htm
Mottevali, G. (2014). Iran’s brain drain is the West Gain. Bloomberg Business.
Retrieved July 31, 2015, from http://www.bloomberg.com/bw/arti-
cles/2014-05-08/irans-best-engineering-science-grads-take-skills-abroad
Mullan, F. (2005). The metrics of physicians brain drain. New England Journal of
Medicine, 353, 1810–1818.
Online, 23(5), 634–641.
Ray, D. (1998). Development economics. Princeton, NJ: Princeton University Press.
Sakiko Fukuda-Parr. (2006). The human development index, a multidimensional
measure in Poverty in Focus. Geneva: UNDP. 7–10. Retrieved January 5, 2015,
from http://www.ipc-undp.org/pub/IPCPovertyInFocus9.pdf
Saniotis, A. (2007). Changing ethics in medical practice: A Thai perspective.
Indian Journal of Medical Ethics, 4(2), 24–25.
Scheper-Hughes, N. (2013, September 13). Organ trafficking: A protected crime.
The Conversation. Retrieved January 11, 2015, from https://theconversation.
com/organ-trafficking-a-protected-crime-16178
Sen, A. K. (1983). Development: Which way now? Economic Journal, 93,
745–762.
Sen, A. K. (1984). Resources, values and development. Oxford: Basil Blackwell.
Sen, A. K. (1985). Commodities and capabilities. Oxford: Elsevier Science
Publishers.
Sen, A. K. (1999). Development as freedom. Oxford: Oxford University Press.
Sethi, S. (2014, October 5). UN report warns of rising poverty in Asia. Press TV
New Delhi. Retrieved January 9, 2015, from http://www.presstv.ir/
detail/2014/10/05/381126/un-report-warns-of-rising-poverty-in-asia/
Cambridge, MA: Harvard University Press.
116 F. NAHAVANDI
Streeten, P. (1984). Basic needs: Some unsettled questions. World Development,

12(9), 973–978.
Tankwanchi, A. B. S., Özden, C., & Vermund, S. T. (2013). Physician emigration
from Sub-Saharan Africa to the United States. Analysis of the 2011 AMA
Physician Masterfile. PLOS Medicine 10(9). doi:10.1371/journal.
pmed.1001513
Tebeje, A. (2005). Brain drain and capacity building in Africa, Canada: International
Development Research Center. Retrieved October 26, 2014, from http://
web.idrc.ca/en/ev-71249-201-1-DO_TOPIC.html
Townsend, P. (2006). What is poverty? An historical perspective. In Poverty in
focus. Geneva: UNDP. 5–7. Retrieved January 5, 2015, from http://www.
ipcundp.org/pub/IPCPovertyInFocus9.pdf
Townsend, P. (1979). Poverty in the United Kingdom. London: Penguin.
United Nations Development Programme. (2014). Human development report
2014, sustaining human progress: Reducing vulnerabilities and building resil-
ience. New York: UNDP. Retrieved July 20, 2015, from http://hdr.undp.org/
en/content/human-development-report-2014
United Nations Human Rights. (2014). Special Rapporteur on extreme poverty and
human rights. Retrieved January 5, 2015, from http://www.ohchr.org/EN/
Issues/Poverty/Pages/SRExtremePovertyIndex.aspx
Whittaker, A. (2010). Challenges of medical travel to global regulation: A case
study of reproductive travel in Asia. Global Social Policy, 10(3), 396–415.
Whittaker, A. (2011). Cross-border assisted reproduction care in Asia: Implications
for access, equity and regulations. Reproductive Health Matters, 19(37),
107–116.
Whittaker, A., & Speir, A. (2010). “Cycling overseas”: Care, commodification,
and stratification in cross-border reproductive travel. Medical Anthropology,
29(4), 363–383.
World Health Organization. (2010). Health system financing: The path to universal
coverage. World Health Report 2010. Retrieved July 23, 2015, from http://
www.who.int/whr/2010/en/
CHAPTER 8
Ending Remarks
Abstract In the conclusion, Nahavandi argues that as human body parts

have now entered the transnational market either legally or illegally, the
usual mechanisms of the global markets apply to them—among others,
the perceived or genuine shortage or scarcity of these resources, which is a
driving force for outsourcing or attracting them. The supply often comes
from the Global South where the motivations for selling are rooted in
poverty, inequality and disarray or unsatisfied aspirations in case of brain
migration. Changing these motivations by eradicating their causes can be
part of the answer to the issues raised by the commodification of human
body parts and the unequal exchange by way of which extraction of new
resources from the Global South are still continuing.
Keywords Resource • Global market • Import country • Export country

• Scarcity • Shortage
This book has addressed commodification of the human body referred to

as the transformation of persons and their bodies into objects of economic
desire by way of commercialization and trade of human body parts. Four
cases, hair, womb, kidney and brain drain have been analyzed through
the supply and demand lens. The two objectives of this book were to
first, address related issues that illustrate different degrees and forms of
commodification of human body parts that usually are studied indepen-

DOI 10.1057/978-1-137-50584-2_8
118 F. NAHAVANDI
dently from one another, and second, to argue that the commodification
of human body parts represents a new process of circulation of resources
mostly from the Global South to the Global North within today’s global
market and should also be analyzed as a development-related issue. In this
framework, the book highlights that whatever the reasons lying behind
the growing demand for hair, womb, kidney or brain, those body parts
have become resources defined broadly as: “a useful or valuable possession
or quality of a country, organization, or person” (Cambridge Dictionary)
or as “a stock or supply of money, materials, staff, and other assets that
can be drawn on by a person or organization in order to function effec-
tively” (Oxford Dictionary), and therefore new types of commodities.
These valuable possessions have now entered the global market legally or
illegally. They all have a price, paid either in money or residence permits,
and are sought after, sold, bought, negotiated and advertised.
Such is the case of the Global South women’s natural hair. The global
market for human hair has passed the threshold of a million dollar per
year business. As for many products today, there are source countries
of raw materials, mainly in the Global South, and countries specializing
in the treatment of hair, such as China, a big importer of natural hair
and at the same time a main exporter of the treated one. And, finally as
for any resource there are main importers, the United States and Great
Britain being the first among them. However, the demand has increased
for some consumers in the Global South, for example Africans, and some
less wealthy people such as African-American women in the United States
in search of identity. In this framework, the South-North circulation of
resource also intersects with a South-South circulation and the boundary
between wealthy buyers and poor suppliers is blurred.
Surrogacy is another case whereby a Global South’s women’s body part
has become commoditized to give birth for usually wealthy couples or
individuals. It has also become a multibillion-dollar enterprise in which an
international division of labor is now ‘normalized’. Poor women from the
Global South rent out their womb to wealthy individuals mostly coming
from the Global North, but also to a lesser degree to wealthy people from
their diaspora or region. Surrogacy involves fees to the agency, gestational
carrier, attorney and social worker, along with legal and medical costs,
money to cover the carrier’s maternity wardrobe and travel expenses and
the costs of harvesting the egg or embryo. However, if one can afford it,
the surrogacy can be financed by grants or loans just like international
adoption, which can cost between $ 25,000 and $ 50,000. Today, com-
missioners may be considered “like companies that outsource labor to
ENDING REMARKS 119
other countries, traveling to purchase a cheaper source of reproductive

labor” (Windance Twine 2011, p. 1). In turn, transnational surrogacy is
highly stratified and mediated by the racial, gender and economic inequal-
ities in the source countries. In transnational surrogacy, too, there are
supplier countries such as India and Thailand, and importer countries usu-
ally belonging to the Global North, such as the United Kingdom and
Australia.
Kidneys have also entered the market though most often through traf-
ficking. Kidney transplantation is also a stratified process where, among
others, nationality, race, gender and inequalities intersect. Clearly, within
the kidney market, there are also supplier countries and importing coun-
tries, although the process is more complex whenever supply countries may
also be ‘processing countries’, which is the case of India, when Bangladesh
kidneys are exported and transplanted to people from other countries.
As for the attraction of brains in today’s global market, it can be linked
to the value granted to human capital skills within the migration process.
The qualifications of migrants have a value expressed in points rather than
money, as is the case in Canada and New Zealand for example and pre-
sented in Chap. 6. Attraction of brains rests upon the duty felt by emi-
grants towards their families, their unsatisfied ambitions and the global
race for talent, which is going on within today’s economic order. In the
process of attraction of brains, there are also exporting countries mostly
from the Global South and importing countries from the Global North.
As all these resources enter the global market, the usual characteristics
and mechanisms of the global markets apply to them. Among others, the
perceived or genuine shortage or scarcity of these resources—a founding
element of economics—is a driving force for outsourcing or attracting
them. Typically, a shortage occurs whenever quantity demanded is greater
than quantity supply at the market price. More people are willing and able
to buy the good at the current price than the available supply. This mecha-
nism is fuelling the market for natural hair. The supply of natural hair in
the Global North cannot respond to the demand, leading to outsourc-
ing in the Global South. In turn, scarcity is a naturally occurring limita-
tion on the resource that cannot be replenished. Economics never bother
about absolute scarcity, which means that goods are not available at all. It
focuses on relative scarcity, which measures scarcity in relation to demand.
Whatever the reasons, the stocks of wombs, kidneys and brains available in
the Global North do not respond to the felt needs, demands and aspira-
tions. This assessment together with the reality of today’s globalization
and neoliberal order has led to outsourcing in the Global South. Hence, in
120 F. NAHAVANDI
economics, demand determines everything. If there is no demand, there

will not be the question of scarcity of a good.
This book has addressed various aspects of the demand for hair, wombs,
kidneys and brains. For example, even though, in the United States, the
cost of surrogacy to the intended parents, including medical and legal bills,
runs from $ 40,000 to $ 120,000, the demand for qualified surrogates is
well ahead of supply. However, as for any market today, advertising plays a
significant role. Some aspects of the latter have also been presented in the
above chapters. Therefore, the remaining question is: “what if there is no
supply?” In this framework, prohibition is extensively discussed as it may
fuel more underground practices and force both suppliers and commis-
sioners into more vulnerable positions. Obviously, the demand for talent
functions through different channels as the global race for the best and
brightest is a matter of hegemony of states. The supply orientates attention
towards the Global South. If we consider that the main suppliers belong to
the Global South, that their motivations for selling are rooted in poverty,
inequality and disarray or unsatisfied aspirations in the case of brain migra-
tion; and if we consider that mainstream development discourse heavily
mobilized the necessity to eradicate vulnerability in the Global South, we
can then consider that the success of the latter could also be a part of the
answer to the issues raised by commodification of human body parts. One
of these discourses is the 2014 UNDP Development Report (2014), which
addresses vulnerabilities. Taking a people-centered approach, it highlights
“the need for both promoting people’s choice and protecting human devel-
opment achievements. It stresses the importance of identifying and address-
ing persistent vulnerabilities by building resilience and enhancing people’s
capabilities to cope with shocks – financial, natural or otherwise”. It also
highlights that almost 1.5 billion people are still multi-dimensionally poor,
with overlapping deprivations in health, education and living standards and
close to 800 million people are vulnerable to failing back into poverty when
setbacks occur. Without any doubt, the above categories fuel the commodi-
fication of body parts, at least the supply of hair, wombs and kidneys.
Clearly, the geography of commodification parallels the three parts of
the world: developed, emerging and least developed. For more than two
centuries now, trade with colonized, or later with the so-called develop-
ing countries, has existed, as did purchasing cheap labor and goods from
abroad as well as outsourcing. However, “outsourcing of production,
especially to countries with low wages costs, has gained impetus since the
1970s. Having initially been unskilled jobs in particular that were out-
sourced, the trend has now progressed to see more specialized functions
ENDING REMARKS 121
also relocated to low-wages countries” (Danish Council of Ethics 2013,

p. 12). Globally, features of sending or supplier countries differ from
those of recipients’ in many ways: GNP, HDI, poverty indicators, health
spending, mortality rates, mother mortality, number of doctors, num-
ber of available hospital beds, internet use, R&D investment, services,
highly skilled migration rate and so forth. Many of these factors have been
addressed throughout the chapters of this book. When viewed through a
geographical lens, commodification of human body parts both reinforces
and perpetuates the existing patterns of uneven development between and
within different regions of the world and creates new spatial expressions
of inequality complicating the existing ones. There are as Scheper-Hughes
has mentioned ‘exporting’ and ‘importing’ countries. However, within
the Global South the specializations have introduced new divisions. For
example, many Asian states have emerged as the major country destina-
tions for transplant procedures, or organ supplier regions for the global
market. In turn, no African country outside of South Africa has a sub-
stantial local transplant ‘travel’ sector. The relative absence of transplant
tourism in Africa can be understood according to the same logic as the
widespread absence of even basically functional health care systems that
prohibits the commercialization of organ transplantation. The commodifi-
cation of human body parts is also very stratified in terms of opportunities,
gender and moreover in terms of power within each sex group. The haves
and the have nots are confronted in term of opportunities in health access,
jobs, education, insurance, legal protections, knowledge, Internet access
and other resources.
Finally, what do transnational hair trade, surrogacy, kidney transplant
or attraction of brain have in common? The tale of an uneven world and
the continuity of an unequal exchange by way of which extraction of new
resources from the Global South are still going on. However, all players
in the new game have fully integrated today’s market ideology: everything
has a price and everything is exchangeable; it is an extended version of the
supply and demand scheme. All starve to become consumers even though
their possibilities and opportunities are far from being equal.
REFERENCES
Danish Council of Ethics. (2013). International trade in human eggs, surrogacy
and organs, a report from the Danish Council of Ethics. Retrieved January 20,
2015, from www.etiskraad.dk
Windance Twine, F. (2011). Outsourcing the womb, race, class, and gestational sur-
rogacy. New York: Routledge.
REFERENCES
Aadil Hospital. Retrieved from http://www.aadilhospital.com/

Akanksha Infertility Clinic. Retrieved February 3, 2014, from http://ivf-
surrogate.com/
Al-Masry Al-Youm. (2013, February 27). Five imprisoned for trafficking blood of
street children. Egypt Independent.
Banerjee, A. (2014). Race and a transnational reproductive caste system: Indian
transnational surrogacy. Hypatia, 29(1), 113–128.
Barndt, D. (2004). Tangled routes: Women, work, and globalization on the tomato
trail. Maryland: Rowman and Littlefield Publishers.
Barrow, R. (1968). Slavery in the Roman empire. New York: Barnes and Nobles.
Barry, K. (2006). Home and away: The construction of citizenship in an emigra-
tion context. New York University Law Review, 81(11), 11–59.
Borjas, G. J. (1999). Heaven’s door: Immigration policy and the American economy.
Princeton: University Press.
Bush, M. L. (1996). Serfdom and slavery. London: Longman.
Cambridge Dictionary. Retrieved December 1, 2013, from http://dictionary.
cambridge.org/dictionary/british/resource
Castles, S., & Miller, M. J. (2009). The age of migration: International population
movements in the modern world (4th ed.). Basingstoke: Palgrave MacMillan.
Centre for Equal Opportunities and Opposition to Racism (CFOOR)
L’immigration iranienne en Belgique. Retrieved July 20, 2014, from http://
www.diversite.be/diversiteit/files/File//migratie_migrations/OBSimmig-
riranienne2005fr.pdf
Chiswick, B. R. (Ed.). (2011). High-skilled immigration in a global labor market.
Washington, DC: American Enterprise Institute for Public Policy Research
Press.

DOI 10.1057/978-1-137-50584-2
124 REFERENCES
Chrysalis Surrogacy. Retrieved May 13, 2014, from http://www.bbchrysalis.

com/?gclid=CNHilqajqL4CFSMUwwodqH4Asg and Retrieved October 3,
2014, from http://gaylesbiandirectory.com/directory/the-ivf-experts-thailand-
5782.html
Cohen, G. (2010). Medical tourism: The view from ten thousand feet. Hasting
Center Report, 40(22), 11–12.
Crozie, G. K., & Martin, D. (2012). How to address the ethics of reproductive
travel to developing countries: A comparison of national self-sufficiency and
regulated market approaches. Developing World Bioethics, 12(1), 45–54.
Danovitch, G. M. (2008). Who cares? A lesson from Pakistan on the health of liv-
ing donors. American Journal of Transplantation, 8(7), 1361–1362.
Danovitch, G. M., & Delmonico, F. L. (2008). The prohibition of kidney sales
and organ markets should remain. Current Opinion in Organ Transplantation,
13(4), 386–394.
Davies, D. B. (2001). In the image of God: Religion, moral values and our heritage
of slavery. New Haven: Yale University Press.
Delhi IVF Fertility Research Center. Retrieved January 22, 2015, from http://
www.delhi-ivf.com/india_surrogacy.html
Dickenson, D. (2004). Consent, commodification and benefit-sharing in genetic
research. Developing World Bioethics, 4(2), 109–124.
Engerman, S., et al. (Eds.). (2001). Slavery. Oxford: Oxford University Press.
European Migration Network. (2006). Conditions of entry and residence of third
country highly-skilled workers in EU. Retrieved October 3, 2014, from http://
ec.europa.eu/dgs/home-affairs/what-we-do/networks/european_migra-
tion_network/reports/docs/emn-studies/highly-skilled-workers/emn_
highly-skilled_workers_booklet_feb08_en.pdf
Foxy Hair. Retrieved December 1, 2013, from http://trade.foxyhairextensions.
net/index.php
Gill, S., & Bakker, I. (2006). New constitutionalism and the social reproduction
of caring institutions. Theoretical Medicine and Bioethics, 27, 35–57.
Goldin, I., Cameron, G., & Balarajan, M. (2011). Exceptional people: How migra-
tion shaped our world and will define our future. Princeton: Princeton University
Press.
Government of Canada. (2015). Determine your eligibility. Retrieved January 20,
2015, from http://www.cic.gc.ca/english/immigrate/skilled/apply-who-
express.asp
Great Lengths. Retrieved September 28, 2014, from http://www.greatlengths.
net/en/quality/our-hair/
Great Lengths. Retrieved December 5, 2013, from http://www.greatlengths.
net/index.php
Guha, R., & Spivak, G. (Eds.). (1988). Selected subaltern studies. Delhi: Oxford
University Press.
REFERENCES 125
Gupta, J.-A. (2012). Reproductive biocrossings: Indian egg donors and surrogates
in the globalized fertility market. International Journal of Feminist Approaches
to Bioethics, 5(1), 25–51.
Gürten, Z. (2011). Banning reproductive travel: Turkey’s ART legislation and third-
party assisted reproduction. Reproductive Biomedicine Online, 23, 555–564.
Hatton, T. J., & Williamson, J. G. (1998). The age of mass migration: Causes and
impact. New York: Oxford University Press.
Heron, J. The costs of adoption versus surrogacy. Bankrate.com. Retrieved July 1,
2015, from http://www.bankrate.com/finance/smart-spending/costs-adoption-
vs-surrogacy.aspx#ixzz3MPkYbEXN
Hiranandani Hospital. Retrieved February 3, 2014, from http://www.hiranan-
danihospital.org/
Hochschild, A. (1998). King Leopold’s ghost: A story of greed, terror, and heroism in
colonial Africa. Boston and New York: Houghton Mifflin Company.
International Labor Organization. (2000). Global report under the follow-up to the
ILO declaration on fundamental principles and rights at work. Geneva. Retrieved
January 16, 2015, from http://www.ilo.org/public/english/standards/
relm/gb/docs/gb279/pdf/tc-3.pdf
International Labor Organization. (2012). 21 million people are now victim of
forced labour. Retrieved January 11, 2015, from http://www.ilo.org/global/
about-the-ilo/newsroom/news/WCMS_181961/lang--en/index.htm
Jones, G. (2010). Beauty imagined, a history of global beauty industry. Oxford:
Oxford University Press.
Kahn, S. M. (2000). Reproducing Jews: A cultural account of assisted conception in
Israel. Durham: Duke University Press.
Kant, E. (1981). Grounding for a metaphysic of morals. Indianapolis: Hackett. First
published in German in 1785.
Kolchin, P. (1987). Unfree labor, American slavery and Russian serfdom.
Cambridge: The Belknap Press of Harvard University Press.
Kolchin, P. (2003). American slavery 1619–1877. New York: Hill and Wang.
Lerche, J. (2007). A global alliance against forced labor. Unfree labour, neo-liberal
globalization and the International Labour Organization. Journal of Agrarian
Change, 7(4), 425–452.
Locke, J. (1821). Two treatises on civil government. London: Printed for Butler.
Locke, J., & Macpherson, B. (1980). The second treatise on civil government.
Indianapolis: Hackett Publishing. First published in 1689.
Manzano, A., Monaghan, M., Potrata, B., & Clayton, M. (2014). The invisible
issue of organ laundering. Transplantation, 98(6), 600–603.
March, St. (2014). Baby Gammy: Indian surrogacy clinics want Australian support
to prevent similar situation. ABC News. Retrieved January 16, 2015, from
http://www.abc.net.au/news/2014-08-08/an-india-surrogacy-regulation-
concerns-in-wake-of-baby-gammy-st/5658092
126 REFERENCES
Marriner, C. (2012, September 2). Booming surrogacy demand sparks exploita-

tion fears. The Sydney Morning Herald. Retrieved September 12, 2014, from
http://www.smh.com.au/national/booming-surrogacy-demand-sparks-
exploitation-fears-20120901-25742.html
Massey, D. S. (1988). International migration and economic development in com-
parative perspective. Population and Development Review, 14, 383–414.
Massey, D. S. (Ed.). (2004). International migration: Prospects and policies.
Oxford: Oxford University Press.
McCracken. (1995). Big hair: A journey into transformation of self. New York:
Overlook Press.
Meltzer, M. (1993). Slavery: A world history (2nd ed.). New York: Da Capo Press.
Migrants by destination and origin. Department of Economic and Social Affairs
(DESA), New York: United Nations. Retrieved March 2, 2014, from http://
www.un.org/en/development/desa/population/migration/data/index.
shtml
Mrozowski, S. (1999). Colonization and the commodification of nature.
International Journal of Historical Archaeology, 3(3), 153–167.
Naqvi, S. A., et al. (2008). Health status and renal function evaluation of kidney
vendors. A report from Pakistan. American Journal of Transplantation, 20,
1444–1450.
Negin, J., Rozea, A., Cloydand, B., & Martiniuk, A. (2013). Foreign-born health
workers in Australia: An analysis of census data. Human Resources for Health.
Retrieved December 2, 2014, from http://www.human-resources-health.
com/content/pdf/1478-4491-11-69.pdf
New Zealand. (2014). Immigration act 2009. Retrieved December 2, 2014, from
http://www.legislation.govt.nz/act/public/2009/0051/latest/
DLM1440303.html
New Zealand Immigration. (2015). Skilled migrant category. Retrieved January
20, 2015, from https://www.newzealandnow.govt.nz/move-to-nz/new-
zealand-visa/work-visa/skilled-migrant-visas
OECD. (2002). International mobility of highly skilled. Policy Brief, July. OECD
Publishing. Retrieved February 1, 2014, from http://www.oecd.org/science/
inno/1950028.pdf
OECD. (2005). Statistics brief. Retrieved March 2, 2014, from http://www.
oecd.org/migration/mig/36064929.pdf
OECD. (2014). International migration outlook 2014. Retrieved January 15,
2015, from http://www.oecd.org/migration/international-migration-
outlook-1999124x.htm
Ofek, G. (2009). Representation of hair in Victorian literature and culture. Surrey:
Ashgate.
Oxford Dictionaries. Retrieved from http://www.oxforddictionaries.com/defini-
tion/english/resource
REFERENCES 127
Paine, Th. (1775, March). African slavery in America. The Pennsylvania Journal
and Weekly Advertiser.
Planet Hospital. Retrieved December 5, 2013, from http://www.planethospital.
com/
Prya, Sh. (2012, November 10). India’s unregulated surrogacy industry. The
Lancet, 380.
Ragone, H. (1994). Surrogate motherhood: Conception in the heart. Boulder:
Westview.
Rai, S. (2010, September 22). More and more Indians want egg donors, but only
if they’re from the right caste. The Global Post.
Raj Hair International. Retrieved April 18, 2014, from http://www.rajhairintl.
com/about.htm
Rothgang, M., & Schmidt, C. M. (2003). The new economy, the impact of immi-
gration, and the brain drain. In D. C. Jones (Ed.), New economy handbook.
Amsterdam, New York and Tokyo: Elsevier Science.
Scheper-Hughes, N., & Ph., B. (Eds.). (2003). Violence in war and peace: An
anthology. London and Malden, MA: Basil Blackwell.
Scheper-Hughes, N., & Waquant, L. (Eds.). (2002). Commodifying bodies.
London: Sage.
Sen, A. K. (2004). Capabilities, lists and public reason: Continuing the conversa-
tion. Feminist Economics, 10(3), 77–81.
Sensible Surrogacy, Info@SensibleSurrogacy.com. Retrieved October 3, 2014,
from http://www.SensibleSurrogacy.com ; http://www.zipleaf.us/
Companies/Sensible-Surrogacy; http://www.sensiblesurrogacy.com/about-
us/
Smith, A. (2011). An inquiry into the nature and causes of the wealth of nations.
New York: Cosimo, Inc. First published in 1776.
Sutton, D. (2012). Globalizing ideal beauty: Women, advertising, and the power of
marketing. New York: Palgrave Macmillan.
The World Health Report. (2006). Working together for health. Retrieved
December 15, 2013, from http://whqlibdoc.who.int/publica-
tions/2006/9241563176_eng.pdf
United Nations. (2013a, September 2). Population facts. Retrieved March 2,
2014, from http://esa.un.org/unmigration/documents/The_number_of_
international_migrants.pdf
United Nations. (2013b). Trends in international migrant stock: The 2013 revision-
migrants by age and sex. Retrieved July 20, 2015, from http://www.un.org/
en/development/desa/population/publications/pdf/migration/migrant-
stock-age-2013.pdf
United Nations. (2013c). World migration report 2013. Retrieved January 6,
2014, from http://www.un.org/en/development/desa/population/publica-
tions/pdf/migration/migrationreport2013/Full_Document_final.pdf
128 REFERENCES
Weisberg, K. (2005). The birth of surrogacy in Israel. Gainesville: University Press

of Florida.
Weitz, R. (2001). Women and their hair: Seeking power through resistance and
accommodation. Gender and Society, 15(5), 667–686.
Whittaker, A. (2008). Pleasure and pain: Medical tourism in Asia. Global Public
Health: An International Journal for Research, Policy and Practice, 3(3),
271–290.
World Food Program. (2013). The state of food insecurity in the world. Retrieved
December 10, 2013, from http://www.fao.org/docrep/018/i3458e/i3458e.
pdf
Yee, J. (2012). European crisis boosts illegal trade in body parts. BioEdge.
Retrieved July 24, 2015, from http://www.bioedge.org/bioethics/
european_crisis_boosts_illegal_trade_in_body_parts/10107
Yuval-Davies, N. (1989). National reproduction and the ‘demographic race’ in
Israel. In F. Anthias & N. Yuval-Davies (Eds.), Woman-nation-state. London:
MacMillan.
Zavodny, M. (2011). Immigration and American jobs. American Enterprise
Institute and the Partnership for a New American Economy. Retrieved from
http://www.aei.org/files/2011/12/14/-immigration-and-american-
jobs_144002688962.pdf
Zelizer, V. (2011). Economic lives, how culture shapes the economy. Princeton:
Princeton University Press.
Zimmermann, K. F. (1999). Tackling the European migration problem. Journal
of Economic Perspectives, 9, 45–62.
INDEX
A baby farm, 46, 53

actors, 7, 13, 42, 61, 67, 78, 96, 102, Bangladesh, 61, 63, 64, 67–9, 97, 98,
103 101, 117
adoption, 45–7, 62, 65, 81, 116 basic need, 5, 96, 102, 107
adverse inclusion, 101, 102 Bauer, Thomas. K., 77
Africa, Sub Saharan, 108, 110, 111 Becker, Gary, 21, 25
agenda, post 2015, 5 Berry, Esther, 24, 38
angel, 52 Bertoli, Sabine, 76, 82
anthropology, 18, 21 Bettie, Julie, 34
Appadurai, Arjun, 15, 19, 21, 44 biocapitalism, 64
appropriation of resource, 1, 4, 8, 9, biomedicine, 44, 54
16, 31, 38, 94 biotechnology, 13, 23, 62
Asia, 5, 53, 62, 86–8, 100, 103, 104 bioviolence, 64, 71
aspiration, 5, 104, 107, 115, 117, 118 Blue card, 81, 83, 88
attraction of brains, 3, 8, 9, 17, 18, body shopping, 13, 18, 85
25, 75–88, 93, 95, 103, 105, Boeri, Tito, 76, 77
108–13, 117, 119 Bosi, Stefano, 77
Australia, 18, 45, 47, 63, 79, 80, 87, brain drain, 3, 7, 17, 24, 76, 77, 88,
97, 98, 108, 110, 117 104, 108–13
assisted reproductive tehcnology, 23, 54 Brazil, 37
bright and brightest, 94
broker, 2, 17, 44, 45, 49, 50, 61–4,
B 67, 69, 102
baby factory, 3, 43. See also hostels; buyer, 4, 22, 44, 61, 64, 116
housing

DOI 10.1057/978-1-137-50584-2
130 INDEX
C disparity, 97, 100, 108

Cambodia, 35, 53 Docquier, Frédéric, 24
Canada, 63, 78, 79, 83, 97, 98, 108, doctors, 2, 13, 20, 47, 48, 50, 51, 67,
110, 112, 117 70, 87, 108, 110–12, 119
capitalism, 13, 38, 47, 49, 54, 64, 71 donor
Carney, Scott, 24, 35, 50 compensated living unrelated, 70
Cherry, Mark J., 22 egg, 16, 42, 43
China, 35, 44, 47, 54, 63, 69, 70, 86, dowry, 68, 69
88, 98, 100, 103–5, 116
class, 7, 9, 34, 38, 47, 48, 51, 103
Cohen, Glenn, 68 E
Cohen, Lawrence, 61, 63, 64, 67, 68 education system, 7
colonialism, 8, 24 Egypt, 31, 69, 100
colonization, 4, 9n1, 14, 24, 93, 94 Ehrenreich, Barbara, 49
commodification, 1–9, 9n1, 13–25, El Boudamoussi, Samira, 7, 9n1
31, 32, 54, 71, 76, 83, 93–113, embodiment, 50, 51, 94
115, 118, 119 embryo, 23, 43, 54, 116
community, 22, 50, 62, 102 Emmanuel, Arguiry, 7
competition, 2, 43, 64, 70, 76–9, 83, ethics, 18, 21, 24, 118
87, 106 European Union (EU), 81, 83, 88
Cooper, Wendy, 34 exploitation, 2, 4–6, 9n1, 21–4, 38,
Cuthbert, Denise, 17, 45, 46 42, 44, 49, 70, 71, 94, 108
cyclosporine, 60, 61
F
D Facchini, Giovanni, 77, 79–82
Davies–Floyd, Robbie, 42 Falun Gong, 70
debt, 3, 65, 67–9 fertility, destination, 16, 17, 42–4, 46,
dehumanization, 21–4 52
demand, 1, 2, 4, 8, 9, 14, 17, 20, 32–7, fetus, 42, 47, 51
41, 43–8, 54, 62–3, 69, 76–85, Food and Agriculture Organization
88, 93, 102, 107, 109, 115–19 (FAO ), 5
Deomampo, Daisy, 49, 52, 97, 102 Foucault, Michel, 19, 20
deterioration of health, 68, 69 Fox, Renee, 20, 23, 24
developing countries, 3, 5, 6, 8, 16, France, 8, 32, 81, 82, 84, 97, 98
24, 38, 62, 64, 77, 85–7, 95, Fronek, Patricia, 17, 45, 46
101, 102, 105, 108, 111–13, 118
diaspora, 46, 105, 116
Dickenson, Dona, 13, 16, 23 G
discourse, 14, 51, 52, 64, 101, 113, Gender, Inequality, 98–101
118 Germany, 32, 82, 83
discrimination, 46, 101 gift, 16, 17, 20–1, 51, 52
disembodiment, 50, 51 Global
INDEX 131
North, 4, 6, 8, 16, 17, 33, 52, 54, ILO. See International Labor
75–7, 83, 85, 93, 97, 104, Organization (ILO)
115–17 immunosuppressive drug, 59
South, 4, 7–9, 16, 32, 35, 48, 52, India, 8, 35–7, 42, 43, 45, 48–53,
60, 62, 64, 76, 88, 94, 95, 97, 61–3, 67–9, 85, 86, 88, 98, 100,
101, 102, 104, 105, 107, 108, 101, 103, 104, 107, 117
115–19 Indian temple, 36. See also Hindu
globalization, 4–6, 9n1, 17, 24, 44, temple
49, 62, 77, 109, 117 inequality, 4–6, 24, 94–108, 111, 118,
goods, 1, 2, 19, 33, 42, 47, 49, 76, 119 gender inequality
88, 102, 106, 107, 117, 118 Indonesia, 35, 64, 100
graduate student, 83–5 Inhorn, Marcia C., 17, 45
green card, 82, 88 Injection, 50
Insurance company, 60
Intended parent, 42, 43, 50, 118
H International Labor Organization
hair (ILO), 24, 85
artificial, 31, 32 Internet, 6, 43, 60, 63, 69, 119
extension, 2, 3, 31–3, 35, 36, 38 Iran (Islamic Republic), 70
natural, 2, 31, 32, 35, 37, 38, 116,
117
selling, 2, 102 K
trade, 6–9, 31–8, 88, 93, 95, 119 Kant, Emmanuel, 19
health system, 106, 107, 110 Kapur, Davesh, 18, 25, 77, 79, 82,
hegemony, 2, 6, 118 112, 113
highly skilled, 17, 18, 24, 75–9, 81–8, Karandikar, Sharvari, 48–50
104, 109, 119 Kenya, 34, 107, 110
Hindu temple, 36. See also Indian Kerr, Sari Pekalla
temple Kerr, William, 86, 112
Hiring womb, 9 kidney
Hirschl, Ran, 18, 25, 78, 80, 88 donor, 63
Hochschild, Arlie Russel, 49, 52 failure, 2, 63
holiday, 45, 46 Kimbrell, Andrew, 23
hostels, 50. See also baby factory kinship, 7, 9, 24, 46, 51
housing, 50. See also baby factory knowledge, 2, 9n1, 14, 15, 24, 46, 77,
Hudson, Nicky, 16, 24, 41, 45, 46 81, 93, 96, 97, 99, 102, 112, 119
human rights, 61, 69, 96 Koslowski, Rey, 77, 79
hunger, 5, 97 Kumar, Raghu, 43
I L
ideology, 23, 46, 47, 52, 119 labor market, 8, 77, 79, 80, 83, 84,
Ikels, Charlotte, 23 88, 99, 100
132 INDEX
Latin America, 86, 103 Moniruzzaman, Monir, 61, 63, 64,

Lebanon, 65 67–9, 71
Locke, John, 18 monitoring, 50, 95
Lowell, Lindsay, 24, 81, 109 motherhood, 16, 23, 24, 42, 46
Myanmar, 37
M
majbouri, 49 N
Majumdar, Anindita, 48–52 Naqvi, Anvar, 64, 65
market narrative, 24, 51, 52, 67
black, 1, 17, 21, 54, 63, 64, nationality, 9, 51, 70, 117
70, 71 neo-cannibalism, 7
driven economy, 6, 9 neo-colonialism, 7
free, 1 neoliberal economic order, 4
global, 1–3, 6, 9, 13, 16, 24, 35, New Zealand, 79, 80, 83, 87, 117
38, 48, 54, 71, 93, 102, 106, Nigerian, 34
115–17, 119 nurturance, 51
migration, 79
oriented policy, 76
rhetoric, 9, 15, 17 O
Martin, Lauren Jade, 24, 25, 43 OECD. See Organization of for
Marway, Herjeet, 15 Economic and Co-Operation
Marx, Karl, 19, 96 Development (OECD)
Mauss, Marcel, 19 Organization of for Economic and
McHale, John, 18, 25, 77, 79, 82, Co-Operation Development
112, 113 (OECD), 77, 78, 83, 84, 86–8,
medical anthropology, 18 103, 111
Mendoza, Roger Lee, 61, 62, 64, 66, outsourcing, 117, 118
67 Oxfam, 5
Mexico, 43, 45
migrant, 3, 18, 75–7, 79–83, 86, 88,
104, 111, 117 P
migration Paguirigan, Medel Salvador, 66, 67
of brains, 2 Pakistan, 62, 63, 65–6, 68, 98, 100
policy, 80, 83 Pande, Amrita, 24, 48–52
millennium development goals, patriarchy, 47
5, 85 Pfeffer, Naomi, 17, 42, 45, 105, 106
Miller, Barbara, 33 philanthropy, 45
Mitchell, Robert, 20 point system, 79–82
Moazam, Farhet, 64 poor, 4, 5, 7, 16, 22, 23, 32, 33, 35,
money, 19, 36, 47, 49, 51, 52, 61, 70, 37, 38, 48, 52–4, 60–2, 64, 67–9,
71, 85, 109, 116, 117 97, 99–103, 107–10, 113
INDEX 133
poverty reduction, 5 Sharp, Lesley, 15, 17, 20, 24,

pregnancy, 50, 51, 54, 100 62, 68
shortage, 59, 70, 75, 77, 81–3, 111,
117
Q slavery, 4, 14, 22, 34, 65, 94
queue jumping, 45 slum, 3, 35
social exclusion, 101
social injustice, 7, 97
R Spar, Deborah, 42–4
race stigma, 45, 51, 52, 69
for power, 2, 24 strategy, 33, 51–3, 85, 105–7
for talents, 17 stratification, 52, 102
Radin, Margaret Jane, 1, 4, 22, 23 surrogacy
Rainhorn, Jean–Daniel, 7, 9n1 contract, 49, 50
ranking, 2 industry, 8
Rapoport, Hillel, 24, 109, 111 surrogate mother, 16, 43, 53
religion, 7, 9, 45, 101 Sutton, Denise
reproductive center, 3 Swazey, Judith, 20, 23, 24
reproductive service, 2 Synott, Anthony, 34
research and development, 7 syrian
resource, 4–9, 16, 31, 38, 49, 50, camps, 64, 65
54, 60, 71, 76, 77, 82, 88, 94, refugee, 64, 65
95, 103, 106, 108, 110, 115–17,
119
Rocafort Gatarin, Gina, 62, 64, T
66, 67 talent, 2, 6, 14, 17, 18, 76–83, 85, 88,
rural areas, 37, 48, 107 109, 112, 117, 118
Russia, 35, 37 technology, 6, 23, 33, 44, 46, 48, 50,
54, 61, 71, 76, 77, 82, 85, 86,
103, 107, 108, 112
S terminology, 16–18
scarcity, 21, 63, 108, 111, 117 Thailand, 42, 43, 45, 48, 53, 54, 61,
Scheper–Hughes, Nancy, 7, 14, 15, 17, 98, 100, 108, 117
20, 23, 60, 63, 64, 66, 101, 119 Titmuss, Richard, 19, 20
science, 2, 6, 18, 21, 33, 44, 64, 70, Tober, Diane, 24, 70, 71
81, 84, 86, 87, 112 tourism, 6, 16, 17, 42, 45, 51, 60, 61,
selected migration regime, 76 63, 65, 106, 119
sellers, 9, 13, 17, 21–3, 35, 36, 61, transnational
63, 65–71, 101, 102, 106, 113 hair trade, 31–8, 93, 119
Sen, Armitya, 96 kidney transplant, 59–71
Shachar, Ayalet, 17, 18, 25, 76, 78, reproduction, 41
80, 97 surrogacy, 17, 41–54, 116, 117
134 INDEX
transplant vocabulary, 16, 48, 49

professional, 62 Vora, Kalindi, 45, 48, 50, 51
rejection, 59
tourism, 17, 60, 61, 65, 119
traffic, 17 W
Turkey, 69 waiting list, 2, 60, 63
Waldby, Catherine, 20
website, 2, 7, 43, 63
U Weitz, Rose, 34
Unequal exchange, 4, 7, 119 Whittaker, Andrea, 17, 105, 108
United Kingdom (UK), 18, 35, 45, Windance Twine, France, 116
46, 79, 82, 84, 87, 108, 110, World Health Organization
111, 117, 1112 (WHO), 61
United Nations (UN), 5, 69, 78, 96,
102, 109
United States (US), 18, 22, 32, 33, X
35, 43, 48, 53, 60, 63, 79, 81, Xiang Biao, 13, 18, 25, 85
86–8, 97, 98, 104, 108, 110,
112, 116, 118
Y
Yea, Sallie, 63, 64, 66, 67
V
value, 15, 19, 46, 69, 77, 81, 96, 99,
117 Z
Vietnam, 35, 37, 54, 98 Zelizer, Viviana, 46, 47
visa, 80–3 zombie, 24

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COMMODIFICATION OF

BODY PARTS IN THE

Transnational Inequalities and

ISBN 978-1-137-50583-5 ISBN 978-1-137-50584-2 (eBook)

Library of Congress Control Number: 2016936511

© The Editor(s) (if applicable) and The Author(s) 2016

Printed on acid-free paper

This Palgrave Macmillan imprint is published by Springer Nature

2 Commodification of Human Body Parts 13

3 Transnational Hair Trade 31

5 Transnational Kidney Transplant 59

6 Transnational Attraction of Brains 75

7 The Commodification of the Human Body Parts

Commodification of the Human Body Parts as a

8 Ending Remarks 117

Table 7.1 Comparative data on some ‘export’ and ‘import’ countries:

Abstract This introduction presents the author’s perspective and outlines

Keywords Commodification • Kidney transplant • Hair sale • Surrogacy

© The Editor(s) (if applicable) and The Author(s) 2016 1

from self” (Radin 1987), a new process of appropriation of resources is

forcing disparities in economic structures, and social conditions between

This book is divided in three parts. First, I present a definition of the

Commodification of Human Body Parts

Abstract Chapter 2 presents a working definition and evidence of using

Keywords Commodification • Objectification • Unequal exchange •

This chapter presents a working definition and evidence of using the

© The Editor(s) (if applicable) and The Author(s) 2016 13

market’ is used to refer to the transnational characteristics of the process

A DEFINITION OF THE COMMODIFICATION OF HUMAN

could lead to an informed knowledge of the phenomenon and to the best

book’s perspectives and the argument presented, all participate in unequal

definition proposed by the European Society of Human Reproduction

OVERVIEW OF THE SOCIAL SCIENCES LITERATURE

the conditions of possibility of medical experience in modern times”

mature death as these are experienced on the margins and peripheries of

Freedom in Markets or Dehumanization?

bioethicists have proposed that a regulated organ market would be an

coexistent with a market order” (Radin 1996, p. 113), and an interdisci-

groups (MacKinnon 1991). Anti-market scholars also reject monetary

Literature Related to the Working Cases

Cherry, M. (2005). Kidney for sale by owner. Washington, DC: Georgetown

Shachar, A. (2009). The birthday lottery, citizenship and global inequality.

Transnational Hair Trade

Keywords Natural hair • Wigs • Hair extension • Feminity • Identity •

© The Editor(s) (if applicable) and The Author(s) 2016 31

from German and Nordic slaves further illustrate the appropriation of a

of beauty. For many people, as stated in an advertisement, “the quality

created the opportunity to develop a booming industry around head hair,

status symbol and many go to beauty salons to get long bone-straight

hair is particularly appreciated, as it is ‘virgin’ and not altered by coloring

To conclude, clearly, the intersection of factors such as identity, class

Abstract Chapter 4 offers an overview of the complex motivations that

Keywords Child desire • Adoption • Surrogacy • Baby factory • India •

Surrogacy is an arrangement in which a woman ‘agrees’—usually under a

© The Editor(s) (if applicable) and The Author(s) 2016 41

the transnational reproduction trade; it can also include, in one way or

THE WOMB AS A COMMODITY

billion annually” (Alford 2014). In India, where there is estimated to be

mission is to provide world-class care to our patients as well as extraor-

market’ (Klein 2014) such as the one organized by Surrogacy Australia, in

The Desire for a Child

arrangements introduce a new ‘custom-made’ market for children. Fees

India, the Most Studied Destination