Wombs for rent

The absence of a law regulating surrogacy makes India, especially Anand, a top destination for couples from abroad.

UNTIL about 2008, the future looked bleak for Sharadaben Solanki. A landless daily-wage worker in Anand, Gujarat, she earned a paltry Rs.600 a month. Her husband earned an equal amount working as a construction labourer. Together the couple supported three children and their parents.

That was when she heard from Maganbhai, the owner of the village shop, that a ladies' clinic in Anand paid women well if they would bear a child for a childless couple.

Sharadaben, 32, met all the criteria. It was radical, she realised, but extremely doable. So she signed up to become a surrogate mother. Nine months later, after delivering a healthy baby girl for a Canadian couple, a delighted Sharadaben had Rs.4 lakh in her bank account.

I would never have made this kind of money even if I worked 24 hours every day for the rest of my life, says Sharadaben. I built a house, bought three acres of land, two cows and two buffaloes in my village, Waghpura, near Anand. I don't have to worry now.

Her investments earn her up to Rs.500 a day. A substantial part of her income comes from selling the milk her cows produce. Sharadaben is among the first of the 300 surrogate mothers from Anand. This small town, famous for its milk cooperative Amul Dairy, is known to have produced more surrogate babies than any other place in the country. Couples from across the world flock to Anand in search of surrogates.

Arguably, there are rights and wrongs to surrogate pregnancies. Carrying someone else's child in the womb for economic reasons is certainly an unusual form of livelihood. Yet, the benefits for both parties seem boundless.

The absence of a specific law regulating surrogacy in India makes it a favourite destination for prospective parents from abroad, particularly couples from the United States and the United Kingdom, where it is prohibitively expensive, says Hari Ramasubramanium, a lawyer with Indiansurrogacy.com. Certainly, stringent legislation is the need of the hour to avoid exploitation and abuse, he says.

Official estimates on the number of surrogate pregnancies in India are not available. SAMA, a women's health organisation, says the assisted reproductive technology (ART) industry in India, which includes surrogacy, is estimated at Rs.25,000 crore. Surrogacy in the U.S. costs upwards of $100,000 in addition to the cost of the in vitro fertilisation (IVF) procedure, whereas in India it costs $23,000 to $25,000 as a package.

Technically there is no law [to regulate surrogacy in India], and secondly it is just one-fourth the cost. That is what makes India an attraction for surrogate pregnancies, says Preeti Nayak, a health worker with SAMA. Not only do we need a proper regulatory framework for surrogacy, we also need to look closely at the health aspect as well.

The government is in the process of making a law to regulate surrogacy. Doctors and health activists, however, have little faith in The Assisted Reproductive Technologies (Regulation) Bill, which is expected to be tabled in Parliament this year. They believe that unless some key issues regarding surrogacy are addressed, this could spiral into a massive racket.

Currently they are playing with fire, says a gynaecologist in Mumbai. I used to have maybe one case a month. Now it is at least one case a week. This has to be regulated and stricter norms must be in place.

Nonetheless, to many women in Anand, surrogacy has come as a boon. Especially for women like Sharadaben who lived a life of misery and abject poverty, it has been life-changing.

ANAND BABIES

Frontline spoke to several surrogate mothers and parents in Anand. Childless couples are beside themselves with joy when they hold their biological children in their arms. The surrogate mothers are usually very content with the monetary remuneration they get for the service: most of the women Frontline interviewed said they did it to buy a house, educate their children, or both.

If there is a way to make your situation better, why not do it? says Sharadaben. I needed the money desperately and look at my life now it is only because of surrogacy.

Dr Nayana Patel, a gynaecologist who runs the Kaival Clinic and Akanksha Infertility Clinic in Anand, says the positives far outweigh the negatives. It needs to be done correctly with emphasis on the medical treatment and in a transparent manner, she says. Anand's trailblazer status in surrogacy owes it to the efforts of Dr Nayana Patel and her husband, Dr Hitesh Patel. Dr Nayana has delivered 381 surrogate babies since 2005. She says on an average 10 couples consult her every week. They come from the U.S., the U.K., Australia, Canada, Israel and Singapore.

Dr Nayana says she is particular about who qualifies as a surrogate and which couple can opt for surrogacy. If a couple comes to me and says they are too busy to go through with a pregnancy as their careers are more important, I reject them immediately, she says.

Further, the couple needs to have a genuine medical condition that leaves only surrogacy or adoption as an option to have a child. For instance, in one case the woman had a kidney transplant. She was fertile but was not allowed to carry a child in her womb. Another woman had a hostile womb. These are severe medical instances which qualify for surrogacy, says Dr Nayana.

Single parents are not entertained as I am not certain about the upbringing of the child in such cases. The child's life is extremely important to us. Therefore, we have several counselling sessions, tests and interviews before we accept a request for surrogacy, says Dr Nayana. She categorically states that no one can just walk into her clinic and ask for a surrogate on payment. Middlemen or agents are simply cut out.

To become a surrogate is not that simple. Dr Nayana takes volunteers only from Anand district. The women need to be between 25 and 40. They should be married with at least one child, and their immediate families husbands, parents, and in-laws need to approve of it before she signs up for surrogacy.

More importantly, the woman has to be medically fit to carry a child. Since the IVF procedure is followed, a battery of tests has to be conducted. Additionally, every legal angle is explored and documents signed before the implantation.

Dr Nayana started her surrogacy programme in 2005 following a successful case where a woman bore her daughter's child. I thought this could make so many people happy if it worked well. I am very particular about the surrogate mothers. I take personal interest in every matter. They are special and I want to deliver every baby myself, says the doctor.

Most deliveries are through Caesarean section. The date is planned so that parents can be present at the time of the delivery. While this reporter was in Anand, a baby had to be delivered before the parents reached from London.

SURROGATE HOUSE

In a well-to-do neighbourhood off Anand's main road is Surrogate House. Dr Nayana says it is compulsory for every surrogate mother to spend the entire duration of her pregnancy here. We cannot take any chances when life and money are involved, she says. This way we administer and ensure the right nutrition and environment.

Several rooms with rows of beds have pregnant women resting in them. The women are used to being interviewed by the media as Dr Nayana's surrogacy programme has gained global fame. Some do not mind their names being revealed or photographs published, but some others are wary of a relative seeing it and the word spreading in the village or the community.

It is a difficult thing for people to accept. In fact, until I convinced my mother she thought it was a form of adultery, says 33-year-old Manisha Patel, who is carrying twin babies for an Indian couple based in the U.S.

I need to build a house and make my children finish school. My husband is a welder whose job hardly fetches a few thousand rupees a month, she says. I used to work in a hospital, so my family has told the other villagers that I have gone for a training course.

She says the hardest part is living away from her children and family. The rules allow the immediate family of the woman to come on Sundays and spend the day with her. But spouses, children and parents are not turned away if they want to drop in during the week.

Manisha is lucky, say her companions sitting beside her. Her party calls almost every day and asks about her well-being and that of the baby. They are very kind people and I feel happy that I am doing something like this. I will benefit and so will they, says Manisha. The couple are even willing to pay for a baby shower next month.

I only met my party once when they came for the procedure. They are not interested in knowing the surrogate, says Lalita Parmar. But the counsellors keep speaking to us about these things and we are okay. Each person has a different experience, she says. Lalita is a mother of two from Petlad near Anand. She was so keen to earn the money that she went through the procedure five times before the implantation worked.

There are 70 pregnant women at Surrogate House. Supervisor and nurse Jagruti Patel says the number has increased manyfold in the past two years.

Pointing to a woman who is sleeping, she says, That woman was widowed two years ago. She works as a housemaid. She could hardly look after her one-year-old daughter. Now she will be able to build a house.

Most of the women are from neighbouring villages and come after hearing about Dr Nayana through some relative who may already have undergone the procedure. Each one has a genuine reason for coming, says Jagruti. They also seem to have an unsaid respect for one another's privacy. This ensures that no one tells people in the community about being a surrogate.

Spending nine months confined to one house is definitely trying. The clinic has set up tailoring, computer and beautician classes on its premises. Dr Nayana says this keeps them occupied, and helps them learn a skill they can put to good use later.

The first thing Papiya Prakash plans to do when she gets her money is to buy her husband an autorickshaw. He has been renting one for seven years. He hardly has any money left after he has paid the owner. We really struggle as we have no land either. I miss being with my daughter, but I tell myself that I am doing this for her, says Papiya.

Tejal Gohel has been a surrogate twice. When I was pregnant with the first child, I wondered whether it would be difficult to give up the child. The doctors kept telling me that I must not believe this is my child. That made it easier to give it up when the time came, she says. And it was not so emotional once I saw the joy on the parents' face. I thought I had two children. Everyone has a right to have a child. The second time around, says Tejal, it was easy.

I had heard that some surrogates got very attached to the babies they carried and was quite anxious, but Vimlaben understood my need and was so gracious, says Jyothi Ranade, who recently had a baby via a surrogate in Anand.

The money the women earn is deposited in a bank account in their individual names. Guidelines laid down by the Indian Council of Medical Research (ICMR) have it that the surrogate should get 25 per cent of the payment when the implantation takes place and the remaining 75 per cent after the baby is born.

Dr Nayana says the clinic's team keeps track of the women's bank accounts. They ensure that relatives do not take any of it or that it is not frittered away on occasions like a wedding. Additionally, Dr Nayana has started a trust to look after the medical problems of each surrogate mother and her dependants for the rest of their lives.

But there are other concerns too. According to ICMR guidelines, no woman who undertakes to be a surrogate can go beyond five pregnancies, which include her own children. Health activists point out that the IVF procedure takes a toll on women's health. Therefore, doctors should be particular about the number of times the procedure is undertaken.

A maximum of three embryos are allowed to be implanted, according to the guidelines. Because of this, quite often in IVF, twins are conceived. Dr Nayana says 30-35 per cent of all her cases are twins.

Premature deliveries are another big risk with IVF. Yet, thanks to medical advancement these babies have an almost 100 per cent survival rate.

In the recent past, there were two controversial cases in India (not in Anand) where surrogate babies were not allowed into their parents' countries.

In 2008, a Japanese father was not allowed back into Japan with his baby as the laws there do not recognise surrogacy. After a long struggle, baby Manjhi got a one-year visa, which would be renewed until the legal issues are sorted out.

In another case, a Norwegian single mother could not take back her twin babies delivered by an Indian in 2009 as Norway does not recognise surrogate babies born from another nationality. She lived in Goa for almost a year before she was allowed back to Norway. The law there was amended to let the children into the country.

LEGISLATION

The ART (Regulation) Bill was first drafted in 2008. The draft was revised in 2010 but is yet to be tabled in Parliament. Women's rights activists allege that the present Bill was constructed by bureaucrats and a few doctors without consulting experts on IVF and women's issues. In its study on the draft Bill, SAMA says, The present draft Bill has substantially reduced the maximum age limit for becoming a surrogate to 35 years from 45 years in the 2008 draft. At the same time, the Bill has increased the number of permissible successful live births to five from three in the 2008 draft. The proposed Bill, however, again does not take cognisance of the significant aspect of the number of cycles a surrogate woman undergoes.

SAMA workers feel withholding the majority of the payment (75 per cent) until the birth of the child is a complete negation of the rights of the surrogate. Considering the potential health risks the surrogate faces, the Bill should make a provision for a more balanced mode of payment to the surrogate, they say. However, doctors say caution should be exercised here as the surrogate could make irrational demands as well.

At Anand, few are willing to speak about the downside of surrogacy, which critics say must be there. Dr Nayana says though she did not plan this to be some social service, it has been emerging this way and she is glad that women in her region are benefiting from surrogacy. The key, she emphasises, is to do it right.