Intimate strangers: Commercial surrogacy in Russia and Ukraine and the making of truth By VeronikaSiegl, Ithaca, NY: Cornell University Press, 2023. 306 pp.

Medical anthropology boasts a dynamic literature examining the ethical and political complexity of assistive reproductive technologies in a range of global contexts. How do the unique formations of post-Soviet medical and social worlds shape experiences for clinicians, surrogate mothers, and prospective parents seeking surrogacy in Russia and Ukraine, and how do various actors make sense of the moral stakes of the surrogacy market? To answer this question, Veronika Siegl's Intimate Strangers, draws on research conducted between 2014 and 2019 in clinics and chat rooms in and around Moscow, Kyiv, and areas of Western Europe (from whence prospective parents seeking surrogates often hailed). Research shows that in other regions, legal commercial surrogacy is often imagined as an altruistic gift, foregrounding the emotional ties between surrogate and intended parents, even as financial exchange takes place. In contrast, Siegl argues, surrogates and clinicians in Russian and Ukraine instead understand surrogacy as first and foremost a form of labor, or an economic contract, and clinicians in Moscow and Ukraine paint surrogates with emotional or altruistic intentions as harder to control or less dependable than those seeking surrogacy for purely financial reasons. Therefore, most surrogate mothers gestating children for others in Russia and Ukraine interviewed by Siegl viewed their roles as work, and their relationship with agencies and intended parents through the lens of market exchange (and therefore, fair or unfair labor conditions). Legal, regulated commercial surrogacy available to citizens and foreigners alike make Russia and Ukraine a destination for prospective parents seeking assisted reproduction. Moreover, the less developed economies combined with geographic and metaphoric proximity to Western Europe made these two nations a destination for Western Europeans seeking a surrogacy arrangement. Intimate Strangers will be a useful text for medical anthropology classrooms, for scholars of assisted reproduction interested in new regional and theoretical perspectives, and for readers interested in feminist scholarship of Eastern Europe and Russia. Medical anthropology of reproductive technologies has long attended to the commodification of bodies; Siegl's reading of post-Soviet subjects involved in surrogacy markets reminds readers that commodification of bodies, viewed through a lens of colloquial Marxism, is always a commodification of labor. Feminisms are structured on practices and ideologies that make up meanings about the body, and attending to the logics and practices of surrogacy-as-labor in Eastern Europe enriches a medical anthropological project of mapping concepts of the body and experiences of embodiment in diverse biomedical and social contexts. The book is arranged into introduction, three parts of several chapters each, a conclusion, and an afterword. Part of the book describes fieldwork conducted in Moscow, while later portions explore related scenes in Ukraine and Western Europe. The introduction situates the project and offers a comprehensive review of recent work in feminist anthropology of assisted reproductive technologies. Tracing the ethical self-work by which surrogates, clinicians, and prospective parents explain and situate reproductive practices in moral terms (15–16), Intimate Strangers offers a compelling extension of the notion of moral economy, explored in the introduction and throughout the text in relation to commercial surrogacy. Chapter 1 reviews the gender politics of post-Soviet Russia, especially the ways in which “compulsory motherhood” is an “essential part of female identity.” Siegl argues that many Russians are suspicious of adoption and dedicated to the pursuit of a genetically related child, a position that dovetails with broader social attitudes that reinforce biological determinist frameworks, and construct surrogacy as both necessary and morally suspect. Chapter 2 details how both surrogate workers and intended mothers hide surrogate pregnancies from peers, friends, and family in the context of Russian public discourse that disparages surrogacy and establishes infertility as shameful. The daily workings of a Moscow fertility clinic are detailed in Chapter 3, along with the choreography of divergent viewpoints of clinicians, prospective parents, and surrogate workers, especially focusing on the financial incentives that lead surrogates into a situation of surveillance and control. Chapter 4 examines the discursive work undertaken by clinic staff to find surrogates with “the right understanding” of surrogacy as a bounded economic relationship, rather than an ongoing relationship of altruism and reciprocity, including employing metaphors that imagine surrogacy as a mechanical or technical process, or casting emotional or extra-contractual concerns as “incomprehensible behavior.” In turn, Chapter 5, examines the emotional self-work that surrogate workers undertake to meet the challenges of aligning themselves with this paradigm of surrogacy. Siegl tracks diverse strategies, from imagining oneself as a nanny, to focusing on the financial benefit to one's own biological children, to imagining the unborn child as genetically or racially other (139–41), as well as subsequent regret that some surrogates expressed following the birth and completion of the arrangement. Shifting the frame, Chapter 6 considers how intended parents in Western Europe understand and make sense of surrogacy arrangements with workers in Ukraine and Russia, and the work that clinics undertake to cater to the more altruistic vision of surrogacy that prospective parents bring to the process. Siegl argues that intended parents mobilize the “moral power of happiness” to justify the need to engage in surrogacy arrangements. In Chapter 7, Siegl considers how parents respond to the view that surrogacy is an exploitative practice, arguing that parents emphasize surrogates’ freedom of choice, a construction in which a free choice may be made under financial pressure, which is distinguished from physical coercion. Moreover, parents rationalize the need to look abroad for surrogacy arrangements in relation to homophobic discrimination at home. In a conclusion, Siegl reviews major arguments within and beyond medical anthropology, considering them in light of emergent surrogacy crises: in Ukraine during the 2020 Covid-19 pandemic, and legal scandals in Russia wherein babies born to surrogates were found to be poorly cared for while awaiting intended parents from China and Thailand. An afterword tracks crises for intended parents, surrogates, and clinics alike following the 2022 Russian invasion of Ukraine. Intimate Strangers tracks several minor themes, explored throughout the text and worthy of further investigation, including: gay men's quest to be parents in the context of Russian political homophobia; classist and racist logics about desirable and undesirable surrogates, gesturing to an opportunity to theorize how surrogacy functions as a “racialized social structure” (see Vora, 2017 on Deomampo, 2016, 225) in multiethnic, hegemonically Slavic, post-Soviet Eurasia; and, the modalities of coercion that clinic workers employ in an attempt to control surrogate mothers during their pregnancies. One problem that the book grapples with is the fuzziness around differentiating Russian and Ukrainian society, which share elements of soviet histories of biopolitics, health care practices, and gender orders (which some Ukrainians may view as the effect of Russian colonial legacies). Siegl documents interconnected surrogacy markets, including Ukrainian surrogates working in Moscow and Russian parents seeking surrogacy arrangements in Ukraine. Occasionally the text allows evidence from Russia to stand for phenomena in Ukraine or vice versa, a slippage that might be read as eliding the perspective that Ukraine is a distinct entity that has too often been lumped together with Russia, a practice that some view as an artifact of a colonial erasure. Yet, this tension is one of the essential (if somewhat accidental) strengths of Intimate Strangers, in that the work documents an ethnographic moment between the 2014 and 2022 Russian invasions of Ukraine, now irrevocably past, that might have looked very different had the ethnographic fieldwork begun in Kyiv rather than Moscow.

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