Veronika Siegl's book Intimate Strangers is an empathetic investigation into the moral economy of surrogacy in Russia and Ukraine. Analysis centers around the concept of “ethical labor,” as actors craft truths of surrogacy as morally upright. These “right understandings” contest two critiques—that surrogacy arrangements are corrupt or coercive. Actors instead flexibly describe surrogacy arrangements as business-like, altruistic, win-win, or free choice. The book is organized into three parts, with an afterword that addresses the impact of Russia's war in Ukraine. Part 1 explores the cultural context and secrecy of surrogacy in Russia. Part 2 turns to surrogates, the business-like relations, and agency surveillance that ensure they are effective, not affective, workers. Part 3 focuses on intended parents from western Europe and the agencies that facilitate their surrogacies. These parents’ concerns about surrogates’ exploitation leads to narratives of happiness and free choice. Siegl's primary contribution lies in the concept of ethical labor, which shows how the economic is made moral. Surrogacy literature has illustrated how surrogacy is both framed by moral understandings and generative of them. Siegl builds on this literature using concepts of moral economy and regimes of truth to demonstrate how different actors advance truths about surrogacy that, despite their fragility, offer moral certainty.Footnote ¹

Reproductive technologies have enabled cross-racial and cross-ethnic surrogacy arrangements, contributing to the global growth of surrogacy even as the practice remains contentious. In the mid-2010s, legal changes restricted surrogacy or made it illegal in some countries in Asia; in response, surrogacy expanded in Russia and Ukraine, where the practice was less regulated and less expensive than in the US. At the time of Siegl's research, surrogacy markets in Russia and the Ukraine were connected. Lower prices and income levels in Ukraine meant that some Ukrainian women served as surrogates in Russia and intended parents in Ukraine were almost all foreign. Agencies promoted Russia and Ukraine as a “moral middle ground” between the unaffordable but ethically superior US and affordable but ethically inferior lower-income countries. It is important to note that Russia banned surrogacy for foreigners, same-sex couples, and single men (and, effectively, gay men) in December 2022 after Siegl's book was written. War in Ukraine has unsettled the surrogacy market there with intended parents looking toward Georgia, Cyprus, or Albania.

The book is based on multi-sited research conducted between 2014 and 2017, primarily in Russia and Ukraine, but also in Germany and Spain. In total, Siegl interviewed 105 surrogacy actors, including thirty-nine surrogate workers, eighteen intended parents from Russia, Spain, Germany, and Austria, twenty-two agents or lawyers, fourteen doctors, along with infertility psychologists, advocates, opponents, and consulate representatives. After a lengthy negotiation, Siegl was allowed to do three months of observations at Altra Vita IVF Clinic in Moscow. Siegl followed two Russian surrogates throughout their pregnancies and one German couple who picked up their twins in Ukraine. In addition, Siegl read online articles and comments, blogs, forums, and clinic websites in German, English, Spanish, and Russian.

Part 1 explores the cultural context and biopolitics in Russia where ideals of motherhood, the state's rhetoric on crises of demography and traditional values, and the influence of the Russian Orthodox Church work together as reproductive and moral governance. Surrogacy is complexly understood as enabling women to fulfill their purpose and saving the traditional family and Russian nation or, alternatively, as transgression against the spiritual and natural orders. IVF is covered by state health insurance, but official Russian Orthodox Church policy is against fertilization outside the body. Many doctors speak of surrogacy as a medical issue, thereby naturalizing it and simultaneously excluding gay or single men as intended parents, reinforcing conservative understandings of gender, sexuality, and kinship. Surrogacy is also thought to enable the reproduction of certain deserving Russians over others—the economic and ethnic elite. Reproductive governance, then, creates both a need for surrogacy and determines its legitimate uses.

Given the contentiousness of surrogacy in Russia, it is shrouded in secrecy. Disclosure to family and friends is fraught, with some providers and intended mothers feeling that disclosure would harm children. In this context, “not telling the whole truth” (79) is ethical labor, part of a larger ethics of care whereby women attempt to protect themselves and others. At the same time, this ethics of care erases the experiences and labor of surrogacy workers.

Part 2 turns to surrogacy workers and the measures taken to control and surveil surrogates such as timed payments, sanctions, and video cameras in agency flats. Surrogates are instructed to think of themselves as crystal vases. Anxiety is heightened by the fact that final payments are tied to the birth of a healthy baby. In a post-Soviet context where there is more of an instrumental approach to intimacy, surrogates in Russia and Ukraine are “practical realists” who plainly describe their financial motives. Surrogacy is regarded as a business-like relationship and surrogates are expected to be effective, not affective, workers.

Intended parents, agents, and doctors are all invested in shaping business-like relations to minimize the presumed danger, unpredictability, and capriciousness of surrogates. Agencies administer tests and screenings to select compliant surrogates with the right understanding. For intended parents entering direct arrangements, the financial motives of surrogates offer security. The anonymization and commodification of surrogacy help prevent emotional entanglements and an ongoing relationship after birth.

Surrogates themselves de-emotionalize their pregnancies, by stressing their indifference to the intended parents and a lack of genetic relation with the child as they carefully calibrate their bonding. Emotions are reduced to instincts or hormones. Drawing on Foucault, Siegl shows how surrogates align themselves (nastraivatsa) through “technologies of alignment” (137)—an ethical labor on the self. This becomes more challenging after birth, as delivery ruptures the divide between the economic and intimate. For some, seeing the baby and meeting the intended parents offers closure, recognition, and the assurance that the child will be cared for. Despite these efforts, the two surrogates Siegl follows both express some emptiness and regret.

Part 3 focuses on intended parents from western Europe and the agencies that serve them. For these actors, ethical labor involves minimizing concerns about exploitation and stressing surrogate altruism and empowerment, thereby humanizing the commercial relationship. These framings exist in other surrogacy markets, for example altruism is more emphasized in the US and empowerment in low-income countries, but both circulate in Russia and Ukraine as the moral middle ground. A gay man in Austria engages in ethical labor when he describes the surrogate as a middle-class woman “who obviously has some kind of calling” (176). Happiness—of both surrogates and intended parents—becomes an individual right and the surrogacy market a means to achieve happiness and freedom.

In the final chapter, Siegl turns to understandings of surrogacy as empowerment where surrogates are autonomous women and intended parents lack choice and freedom. Intended parents and agencies promote surrogacy as a win-win situation but ignore the material inequalities on which surrogacy rests. This chapter is the most ethnographically rich, with Siegl accompanying intended parents who pick up their newborn twins in Ukraine. Although the contract stipulates that the surrogate will not see the babies in the event of a Caesarean section, the twins are born early and Alyona takes care of them for five days before Stefan and Teresa arrive. The circumstances illustrate the risk surrogates assume. While Stefan and Teresa recognize structural inequalities, they see them as inevitable and feel vulnerable themselves. The surrogate “does have a choice” (214) Stefan tells Siegl. Market exchanges reduce ethical considerations to choice, consent, and payment. Like happiness, free choice becomes an ultimate argument.

This book is an important contribution to critical understandings of surrogacy arrangements as shaped by social context. Siegl compellingly shows how the economic is made moral through ethical labor, even as the truths actors espouse remain fragile. Actors labor to keep intimacy and economy separate. Yet surrogacy as an intimate endeavor leaves both surrogates and intended parents vulnerable; surrogacy as an economic relation is also troubling. Thus, actors vacillate between understandings of surrogacy as business and as altruism, flexibly using these truths as needed. Instead of considering possibilities for more trust and care in these relationships, tropes such as consent, happiness, choice, and freedom serve as truths that foreclose more sustained deliberation and relations, ensuring the expansion of the market and the structural power of agencies and intended parents.

Siegl's book makes contributions to scholarship on assisted reproduction, transnational surrogacy, reproductive governance, intimate economies, and ethics. This book will be of interest to scholars across social science disciplines and is appropriate for advanced undergraduate and graduate students.