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Booming Surrogacy Industry in India Raises Legal, Social Concerns

NEW DELHI, INDIA – Chandini, 27, says “motherhood” is the best thing to have ever happened to her – even if she doesn't always get to keep the babies she gives birth to. Chandini, who is three months pregnant, is a surrogate mother, or gestational carrier. She declined to give her full name because of the social stigma attached to surrogacy in India despite the booming industry here.

Holding the hand of her 6-year-old daughter, Chandini enters an in vitro fertilization, IVF, center in a posh South Delhi locality for a checkup.

“I had to change two buses to make it to here,” she says in a hushed voice, smiling as she wipes the sweat off her forehead with the loose end of her cotton sari. “I live in the other end of the city.”

Chandini has a frail smile. Her eyes, darkened with kohl, scan the waiting room of the clinic. Her feet play with her tattered slippers. Chandini says she decided to become a surrogate mother to earn money for her family.

“I want a better life for my daughters,” she says, casually feeling her stomach with her hand.

She's been married for eight years now and has two daughters. Her husband is a daily wage carpenter, who earns 3,500 Indian rupees INR ($80 USD) per month. But his wage isn't enough to support their family, so Chandini works as a housemaid. Together, they manage to pay rent for their quarters in an urban slum and send their daughters to a local municipality school.

But Chandini says they need the extra money, so she became a surrogate. She has been promised 200,000 Indian rupees INR ($4,500 USD) for carrying and delivering this baby.

“This money means a lot to me,” she says.

Chandini says she is carrying for a Canadian couple who could not bear their own child. She declined to give further details.

Like Chandini, hundreds of Indian women rent their wombs to earn money for their families. Although commercial surrogacy is legal in India, there are no laws or a governing body to oversee the rapidly expanding process. Surrogate mothers also face a social stigma attached to carrying children for other couples, as traditional Indian values have not changed as rapidly as the commercial surrogacy industry has grown.

India legalized commercial surrogacy in 2002. Since then, IVF centers have mushroomed, attracting aspiring parents from around the globe, says Sanjay Agarwal, chairman of SATYA, a nongovernmental organization that advocates for the rights of surrogate children. The combination of the low cost of infertility treatment in India – nearly one-quarter of the cost in developed nations – and the modern assisted reproductive techniques available here make India a top choice for infertility treatments, according to the Indian government's medical tourism website. The Confederation of Indian Industry predicts that commercial surrogacy will grow to be a $2.3-billion industry in India by 2012.

Gujarat, a state in western India, has become the unofficial surrogacy capital of the world. Many aspiring surrogate mothers like Chandini travel to Gujarat from faraway poor states, driven by their desperate socio-economic situations.

Dr. Nayna Patel, who became the face of the Indian surrogacy industry when Oprah Winfrey profiled her and her clinic in Gujarat, Akanksha Infertility Clinic, in 2007, says the money earned from being a gestational carrier for couples who can’t conceive transforms lives. In India, 42 percent of the population lives below the international poverty line of $1.25 USD a day, according to UNICEF.

“It's only for our financial difficulties [that] my husband let[s] me do it,” Chandini says.

Chandini says that this is not her first time as a surrogate mother. She says that she has rented out her womb before to earn money.

“It was after I had my own daughters,” she says, sighing. “Daughters mean burden.”

In India, daughters are considered more expensive than sons because of the steep dowry that families must pay their daughters’ husbands when they get married.

But Manasi Mishra, head of a study on surrogate motherhood by the Centre for Social Research, CSR, an institution that aims to restructure gender relations, says that the lives of surrogate mothers aren’t improved much financially.

The CSR study also points out that surrogate motherhood involves more than economics.

“Commercializing a mother’s womb needs to be looked at carefully, because it isn’t just a financial transaction,” Ranjana Kumari, CSR director, says.

Kumari says that when a monetary transaction takes place, the matter becomes even more complicated, as there are no legal provisions to safeguard the interests of the surrogate mother, the child or the parents-to-be.

According to the study, the majority of surrogate mothers are displeased with the way clinics treat them. The women are often coerced into repeated inseminations if the first one failed, not allowed to meet the receiving families and paid only after relinquishing the baby to the clinic.

“Also, in the absence of a law, there are every sort of loopholes, including the rights of surrogate mothers being overlooked in the bargain,” Mishra says.

Although economic conditions in India make surrogacy cheap for couples who want children and profitable for poor surrogate mothers, Agarwal says health care conditions here make it a dangerous process.

“Is it ethical for a country like India, which has one of the worst maternal mortality rates in the world, where a woman dies during childbirth every seven minutes, to promote and allow commercial surrogacy?” Agarwal asks.

Agarwal says that surrogate mothers’ safety is also important because most tend to have multiple children of their own.

“If the woman dies or suffers long-term, serious consequences because of the surrogate pregnancy, then who is going to take care of her own biological dependents?” Agarwal asks.

Chandini says she didn’t know about any laws regarding surrogacy in India. But Patel says that although government laws do not carry sufficient provisions, there are guidelines that IVF clinics follow.

“[It’s] agreed that presently there are no surrogacy laws, but all the reputed IVF clinics have been following many guidelines,” Patel says. “Who says that surrogate mothers are exploited?”

Kumari says she would like to see a law enacted that gives protection and rights to all the parties involved in surrogacy, including the doctor performing the IVF process and delivery, the commissioning family and the surrogate mother.

The Indian Council of Medical Research, ICMR, has drafted the Assisted Reproductive Technology, ART, Bill, which aims to prevent the exploitation of surrogates by infertile couples and vice versa.

Dr. R.S. Sharma, ICMR deputy director general and a member of the ART drafting committee, says that surrogacy in India is not a new practice but that it does require regulation.

“It’s a noble initiative, and there are historical reference[s] of [its] prevalence in the country,” he says. “It needs to be done ... systematically, though. The bill will take some time to become a law.”

Kumari points out that surrogacy also has social ramifications. Although Western cultures may accept commercial surrogacy, traditional Indian values condemn it, and surrogate mothers tend to become social outcasts.

“In a society where married women are totally dependent on their husbands, a surrogate mother can face many levels of violence, including social ostracizing, which is why this topic has been kept under the table by surrogate mothers,” Kumari says.

Chandini says that she doesn’t tell people that she is a surrogate mother. Chandini says she told her daughter, who keeps busy at the clinic playing with “Mummy’s” bangles, that they are there to pick up medicine for a stomachache.

“I don't want anyone to know that I come here,” Chandini says.

Patel says that parting with the baby can be painful for some mothers and that there is a social stigma attached to giving up one’s baby, too.

“But Akanksha has specialized counseling programs for the to-be surrogate mother,” she says. “They are made to meet the commissioning parents, too. And of course they are taken good care of.”

Still, Chandini says it is not an easy way to make money, but that she has few other options.

“It takes a heart to give away a baby you feel growing in your womb for nine months,” Chandini says. “It's what being poor makes you do.”

Quietly, she leaves after meeting with the doctor. (GPI)

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