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SURROGATE A look into India’s surrogacy industry

THE INDIAN SURROGATE — A LOOK INTO INDIA’S SURROGACY INDUSTRY

the INDIAN



by MUHD NURLUQMAN, TAN WEI XIN & DAVID LEE

by MUHD NURLUQMAN, TAN WEI XIN & DAVID LEE

With Special Thanks hedwig alfred Shyam tekwani deepa Suryanarayanan Nikon singapore & Wee kim wee school of communication and information, nanyang technological university, singapore

First Word M

A new mother rests on a bed at the Akanksha Infertility Clinic in Kaival Hospital after giving birth a few hours earlier.

AKE no mistakes about it, India is not the place to migrate to if you are a stickler for cleanliness, efficiency and straightforwardness. Yet, for what it is worth, their indomitable spirit and ability to get on with life in the face of adversity border on the inspirational. The 26/11 Mumbai attacks was as astounding in the extent of the massacre – at least 173 killed and 308 injured – as it was resounding in the indictment of the city’s inability to fight terror. Then again, in India, when you can’t fight, you cope. So just like the 2003 and 2006 Mumbai train blasts and a slew of other attacks, Mumbai was up and running again in a matter of days. It was a good thing too, for we would not have been able to complete our fieldwork about surrogate mothers in India. Of course we were on tenterhooks flying into a terror-stricken state so quickly after such a large-scale assault. However, and this is not from the benefit of hindsight, we somehow felt safe enough to make the trip. And so we went, much to the chagrin of our families and friends. Necessity is the mother of all inventions in India and it seems the concept of surrogate mothers is a classic example of Indian improvisation as well. They are usually poor womenfolk who conceive on behalf of another couple in return for a sum of money they would otherwise take many more years to make. You must understand there are not much career prospects for most of the uneducated women in India. The cost of such procedures in India is also almost a quarter of what clinics in America or Europe charge. Hence, India is fast emerging as a popular destination for childless couples to seek help. Advocates of surrogacy call it a win-win measure. Neutrals feel it is controversial. Opponents wish the idea was never born at all, deeming it exploitative — the childless couple may be held to ransom, or the destitute surrogate mother may be underpaid. Scratch the surface, and surrogate mothers will tell of how the needs of two desperate women are met in such a transaction — the barren gets a baby, the broke gets a bonus. And they all live happily ever after. Dig deeper and the surrogates begin to reveal the trauma and turmoil they experience before plunging into what some of them call the “last decent resort” to pay off debts, buy a house, or save for their children’s education. Even doctors in India are divided on this issue. There are those like Dr Indira Hinduja who feel that adoption should be the way to go for couples unable to conceive. However, most IVF doctors are like Dr Nayna Patel, who recommends surrogacy with stringent guidelines. Then there are some who take it to another realm, such as Dr Gautam Allahbadia, who offers surrogacy options to gay couples. On a personal level, it was difficult to miss how some couples long to have children. We would never understand what it is like to go through 10 failed fertility treatments like Sue did. In her own words, the well-to-do American lady of Korean descent would never imagine herself in a rundown Indian clinic in the middle of a sleepy and dusty rural village, wiping her tears as she tells her story to rookie journalists. The physical and psychological trauma must have been immense. Mother Teresa could not have put it better: “Even the rich are hungry for love, for being cared for, for being wanted, for having someone to call their own.” We think, even more so the poor. Hence, we present to you the story of the surrogate mothers in India, as well as tales from other stakeholders in this burgeoning industry.

CONTENTS page

An embryologist injecting sperm into an egg at the Rotunda Fertility Clinic in Mumbai. The fertilised embryo will then be transferred to the surrogate.

6-9

CRADLE OF THE WORLD An introduction to the surrogacy industry.

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12-17

THE FACE OF SURROGACY An exploration into the lives of India’s surrogates.

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20-23

INDIA’S MOTHER TO SURROGACY Dr Nayna Patel: The pioneer of commercialised surrogacy in India.

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32-33

24-31 THE SURROGATE HOUSE page

A photo-essay on the surrogate hostel in Nadiad, home to Dr Patel’s surrogates for the months that they are pregnant.

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34-35

A PACKAGED DELIVERY

A COUPLE’S LAST RESORT

Surrogacy India, a Mumbai-based surrogacy startup, aims to give foreigners peace of mind, and of course, a baby.

An insight into the thoughts of foreign childless couples who have come to India to seek help.

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38-40

BABY MIRACLE

A Gujarati couple faces an uphill battle after losing three children. Desperate, they turn to surrogacy as the very last attempt to have a child they can call their own.

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the

COVERING BIRTH BEAT Two journalists from India’s biggest newspapers, The Times of India and Daily News Analysis, speak out on the issues covering surrogacy as news reporters.

44-45

SURROGACY in SINGAPORE Surrogacy, both altruistic and commercial, is banned in the bustling city-state. Can it be a solution for its infertile couples who have exhausted every other option?

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36-37

SURROGACY GOES GAY

How a Mumbai clinic is going against the norm by allowing foreign same-sex couples to have their own babies through surrogacy.

01 01 A Gujarati woman coaxes her child, obtained through a surrogate, near Akanksha Infertility Clinic. Surrogacy has given a new line of hope for many Indian and foreign childless couples. 02 A man takes a nap while his wife undergoes an interview to be a surrogate at Akanksha. Behind him are photos of surrogate babies that the clinic has delivered in the last six years.

CRADLE OF THE WORLD Worth an estimated US$445 million (S$680 million), commercial surrogacy is big business in India where 75.6 percent of its population lives on less than US$2 a day. Critics argue that India’s womb-for-rent industry amounts to exploitation, while a new bill is in the works to plug any loopholes in this controversial transaction.

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EVEN months pregnant, Meena is praying that this child will eventually deliver her family a better future. Stroking her swollen belly, the 34-year-old is as excited as any expecting mother, except the baby she is carrying is not exactly hers. When surrogate mother Meena gives birth in Anand’s Akanksha Infertility Clinic, the newborn will be passed on to its biological parents – a childless American couple. Surrogacy refers to the process in which a woman gets artificially impregnated, and after delivery the baby is returned to the commissioning parents. In India, the surrogate mother gets paid for her gestational services. A successful delivery will make Meena Rs250,000 (S$7,444) richer, an

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amount her odd-job labourer husband Haresh would only be able to make in 10 years. “With the money, I won’t have to worry about rent. I can buy a new house. My son will also have an education,” Meena said in her native Gujarati. “And I am also doing a good deed by providing the childless couple a baby.” The couple that hired her had made their way down to the laid-back town from San Francisco, California, close to a year ago, to begin the surrogacy process. Like them, many desperate couples from Singapore to Switzerland, as well as Indians living abroad, are flocking to India with revived hopes of finally being able to have a child of their own, drawn by the attractive combination of highly-qualified doctors, a flexible legal framework and low costs.

Fulfilling a dream John and Sue Lee, both 37-year-old Korean-Americans, have been trying for a baby for the last seven years to no avail. Desperate after failing seven IntraUterine Insemination (IUI) and three In-Vitro Fertilisation (IVF) attempts, the couple decided to turn to surrogacy as a

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last resort after reading about encouraging testimonies on Internet forums. “We have already busted more than US$100,000 (S$153,139) in the States engaging top IVF experts with no results,” John said. “Of course, it helps that it is cheaper over here as we have already depleted much of our savings trying to fulfill our dream. “I think this is a major pull factor for most childless couples thinking about surrogacy.” According to top surrogacy clinics in Ahmedabad and Mumbai, the number of surrogacy cases has soared over the last five years. While there are no firm statistics recorded, doctors say, around 500 to 600 surrogate babies could be born throughout the world each year, with around 200 coming from India. India’s average surrogacy success rate is 37.9 percent — for every 100 surrogacy attempts, about 38 babies are born. Currently, experts estimate the industry to be worth US$445 million, with around 3,000 clinics across India offering surrogacy services. Intended parents are charged around US$20,000 for the entire surrogacy process – from initial consultation to

02

With the money, I won’t have to worry about rent. I can buy a new house. My son will also have an education.” the recruitment of the surrogate, her pregnancy, to the final delivery. This figure could be as low as a quarter of what it would cost in the United States or Europe.

Controversial Despite being hailed as a beacon of hope by many surrogate mothers and commissioning parents, surrogacy remains a controversial issue in India. In 2008, the media reported the case

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of Baby Manji, a child born to an Indian surrogate hired by a Japanese couple through Dr Nayna Patel’s Akanksha Infertility Clinic. Manji’s parents, father Ikufumi Yamada, 46, and ex-wife Yuki, 42, divorced shortly before birth, resulting in the baby getting caught in a legal tussle for months as Indian law prohibits single men to adopt. Neither Yuki nor the surrogate mother wanted to take custody of whom

assurance it offers to all the stakeholders of surrogacy. It states that a surrogate baby will be recognised as the legitimate child of the commissioning couple even if they divorce or become separated, with the child’s birth certificate carrying both genetic parents’ names. The draft Bill also makes it compulsory for foreigners seeking surrogacy services in India to provide documentary proof that they would be

borne by the couple or individual seeking surrogacy”. It adds: “The surrogate mother may also receive monetary compensation from the couple or individual, as the case may be, for agreeing to act as such surrogate.”

Underpaid? There is currently no standard amount that surrogate mothers receive as payment for renting out their wombs. This has led 01

01 G K Mawani and his wife Rama celebrate their son Jay’s birthday in Surat, Gujarat. Jay was born through a surrogate from Dr Bavishi’s clinic in Ahmedabad. 02 A surrogate mother carries her child near Akanksha.

Indian newspaper The Times of India dubbed as the country’s “first surrogate orphan”. Baby Manji was finally allowed to leave the country only after the Supreme Court granted custody to Emiko Yamada, the child’s 75-year-old grandmother. Hence, this unique case also set a precedent in Indian courts deeming commercial surrogacy to be legal.

Shaken Up However, the surrogacy industry could still be shaken up by the upcoming Assisted Reproductive Technology (Regulation) Bill & Rules, which doctors hope would be passed at the next parliamentary session. The main highlight of the new regulation, according to experts, is the

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able to bring the baby back to their home country. Another key clause rules that intended parents seeking surrogacy through assisted reproductive technology (such as IVF), and the surrogate mother, “shall enter into a surrogacy agreement which shall be legally enforceable”. Once the law is enacted in parliament, a committee of experts, NonGovernmental Organisations (NGOs) and fertility clinicians will also have the right to inspect and regulate clinics that offer surrogacy, said Dr Ajesh Desai, director of Gujarat’s State Institute of Health and Family Welfare. Dr Gautam Allahbadia, a member of the drafting committee, said: “All the grey zones in infertility treatment will become black and white.” On the surrogate’s end, the Bill also proposes that all of her expenses shall “be

to debate about whether the surrogates’ interest is adequately looked after. In some instances, surrogate mothers receive payouts as low as Rs25,000, according to the National Commission for Women, an NGO based in New Delhi. Mumbai-based journalist Deepa Suryanarayanan said: “We are concerned. Does the surrogate mother in India, a woman who usually receives little or no education, really know what is stated in the forms before signing them? “Having lived in poverty all her life, would she know whether she is underpaid?” A quick survey of the surrogate mothers’ “rates” in Akanksha’s wards is telling. A Brahmin surrogate will get Rs300,000, while a lower-caste woman can only look forward to about half that amount. Dr Patel remains tight-lipped about

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02

Most people think very badly of surrogacy. They think it means to sleep with other men. So I don’t tell my relatives and friends.”

the exact terms of her clinic’s consent forms – which intended parents and surrogates say are largely about payment and the surrogate mother renouncing her right to the baby. But Dr Patel claims they are translated into the surrogate mother’s native language and explained what each clause means before she puts pen to paper. The 49-year-old doctor was also quick to dispel any doubts as to whether her surrogates will hand over the babies when they are due. “Many surrogate mothers regard it not as ‘handing over’ the baby, but as ‘giving back’ the baby, as the child was never theirs to keep,” she explained. Meena echoed Dr Patel’s views: “I don’t think I will have any harsh feelings about returning the baby to their true parents. I might feel sad, but I know the baby does not belong to me. I will move on and be happy again because both parties will benefit.”

Nothing dishonourable While Meena’s husband understands that “there is nothing dishonourable in surrogacy”, there are many in the conservative Indian society that still regard the practice as taboo. She said: “Most people think very badly of surrogacy. They think it means to sleep with other men. So I don’t tell my

relatives and friends. “It took Madame (Dr Patel) time to explain to Haresh what exactly is surrogacy. But he has been with me all this while, following the procedure, and he doesn’t mind now.” Like Meena, many surrogate mothers are recruited by word-of-mouth. Still, the supply usually cannot keep up with the demand, because practices like Akanksha usually follow a stringent checklist before matchmaking intended parents with a surrogate mother. Dr Patel said: “Say, a childless couple comes through my door and the wife wants a baby so bad, but she has a missing uterus, how can I reject this couple?” “But if a woman says she wants a surrogate to help her carry a baby because she doesn’t want the pregnancy to affect her work or her figure, I won’t even consider. There are more needful couples to help.”

Same-sex Dr Patel also added that, due to personal convictions, she does not entertain any same-sex couples requesting for surrogacy. However, the commercial, and by now global, nature of surrogacy has ensured that there are those who will welcome these clients. Based in Mumbai, Dr Allahbadia’s

Rotunda Fertility Clinic has handled the surrogacy cases of 15 same-sex couples (none from India) that he says form 10 to 20 percentof his clientele. “Ethically, I don’t think there’s anything wrong. Same-sex couples have their rights to a child too. It is hard not to be moved by their genuine desire to have a child,” he said. Legally, there is also nothing to stop gay or lesbian couples from approaching Dr Allahbadia to employ a surrogate’s services in India. However, if the draft bill is passed without amendment, the long queues that proceed directly to clinics such as Akanksha or Rotunda could be a thing of the past. India’s new draft rules stipulate that couples like John and Sue that require a surrogate mother will have to approach surrogacy agencies instead of going straight to an infertility specialist. While the proposed changes could help to boost the surrogacy industry in India by providing an explicit set of rules and regulations, it may also spell the end of Dr Patel’s booming business if she is not allowed to keep her personal pool of surrogate mothers anymore. “The law is the law, I will not go against it. A doctor will always put the welfare of the patients as priority,” Dr Patel said.

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SURROGACY

7 Eastern Europe

MAP OF THE WORLD

- Russia and Ukraine are the only European countries where surrogacy is fully legalised. - Foreign couples are allowed to pursue surrogacy arrangements in both countries.

2 5 1 North America - An estimated 25,000 surrogate babies were born in the US from 1976 to 2007. - A typical payment for a surrogate ranges between US$20,000 (S$30,782) to US$25,000. - States that allow but regulate surrogacy: California, Arkansas, Florida, Illinois, Nevada, New Hampshire, Texas, Utah, and Virginia. - Commercial surrogacy in Canada has been illegal since 2004, although altruistic surrogacy is allowed.

3 4 Southeast Asia - Unclear laws regulating assisted reproductive services make Thailand, Malaysia and Philippines the goto places for foreigners seeking surrogacy services in this part of the world. - All forms of surrogacy are banned in Singapore.

2 Western Europe - Although surrogacy is legal in the UK, no commercial arrangements are allowed and the surrogate mother can only receive expenses – in thousands of pounds through the Surrogacy Arrangement Act – for medical and pregnancy related expenses. - Most women become surrogate mothers for altruistic reasons. Only married couples can participate in a surrogacy agreement. - Countries in the European Union that bans all forms of surrogacy: Germany, Sweden, Norway and Italy.

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3 South Asia - When the Indian parliament passes the Assisted Reproductive Technology (Regulation) Bill & Rules, 2008, surrogate mothers may receive money for carrying the child and all their expenses are paid during pregnancy. - The surrogate mother is bound by law to give up rights to the child, and the child’s birth certificate will have the names of his/ her genetic parents. - Single parents can also have a child through a surrogate mother. - All foreigners renting a womb in India will require documentary proof from their embassy that the child is accepted in the country of his/her genetic parents.

5 East Asia - In Japan, there is no law to regulate surrogate births. Medical councils such as The Japan Society of Obstetrics and Gynaecology as well as the Science Council of Japan have called for surrogacy to be banned. - In 2008, it is reported that more than 100 Japanese couples have used surrogates to have children in the United States. Meanwhile, a law to regulate surrogacy is being studied. - Last year, media reported on a 61-year-old Japanese woman who became a surrogate mother to her own grandchild – possibly the oldest surrogate mother in Japan. - Gestational surrogacy is banned in China.

6 Oceania - In Australia, the state of Queensland bans all forms of surrogacy. - In other Australian states: Victoria, the Australian Capital Territory, Tasmania and South Australia commercial surrogacy is prohibited, except altruistic surrogacy. - Commercialised surrogacy is banned in New Zealand.

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01 Hansha works 14-hour shifts as a nurse at the Akanksha Infertility Clinic in Anand, Gujarat. She received Rs250,000 after successfully delivering a surrogate child to an American couple — an amount 83 times her monthly salary.

THE

FACE OF SURROGACY For most lower-middle class women in India, surrogacy presents a unique opportunity to break free of poverty, though not without its repercussions – the surrogates are often ostracised and misunderstood as being “easy”. But these women are unfazed by all the surrounding controversy as they are driven to earn a better living for their families.

Hansha also has to provide for her 15-year-old little sister and ailing father who lost his leg in a railway accident. They currently live in a makeshift tent along a stretch of train tracks in the dusty town of Nadiad, some 22 kilometres away from Hansha’s flat in Anand. “It’s very hard,” Hansha, 39, said in her native Gujarati. “I have to take care of my family and work also.” Hansha works 14 hours a day, seven days a week, taking the height and weight of patients, measuring blood pressure and giving injections at Anand’s Akanksha Infertility Clinic. It was through her work at the clinic that she learned of the financial rewards in being a surrogate. Hansha became a surrogate mother in December 2007 and delivered twins — a boy and a girl — for a couple from the United States. Her services earned her Rs250,000 — almost seven years worth of her monthly income. For many lower-middle class women in India, surrogacy represents an unique opportunity to escape the sinkhole of low wages and debt. Through surrogacy, women like Hansha can earn decades worth of savings in a mere nine months. “This is the fastest route to money,” said Hansha. Now, Hansha lives in a spartan threeroom apartment with gas stoves and fluorescent ceiling lights, without having to worry about the rent. She has even paid off all her debts. Being able to own, rather than rent, a house is very important in India because it protects you from being held to ransom by unreasonable landlords, Hansha said.

Caste discrepancy

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ARNING a meagre Rs3,000 (S$89) per month as a nurse, Hansha struggles to make ends meet. After spending half of her earnings on rent for her squalid one-room flat that is equipped with neither electricity nor gas, she barely has enough cash to keep her 16-year-old son in school. She worries constantly for her husband — a truck driver — who earns Rs5,000 per trip transporting goods on long haul journeys through India’s treacherous highways. Every time Hansha’s husband leaves, she said, it seems like he is saying his last goodbye.

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To purchase her own apartment, 33-year-old Deepa has also become a surrogate mother. In 2007, she rented out her womb to an Indian couple from the United States and delivered a healthy baby boy. However, the single mother was paid a higher fee as she was born into a higher Hindu caste (Brahmin), compared to Hansha. This is a common discrepancy in one of the most rigid class-bound societies in the world. Many intended parents, especially those of Indian descent, would choose candidates based on their caste, said

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Deepa. “They do not mind paying a bigger price for a higher-caste surrogate. It is a religious thing also,” she said. Carrying a baby for nine months was not easy, Deepa recalled. Besides enduring labour pangs, she also had to hide her swollen belly from friends and relatives. In an intensely patriarchal society, social stigma is a risk that all surrogates carry despite the high dividends. “They think very badly of this thing so I don’t want to tell,” Deepa said. “Because of financial reasons, people do this. Otherwise no one does this.”

Changing attitudes Director of Anand’s Akanksha Infertility Clinic, Dr Nayna Patel has seen her fair share of people who are uneducated about surrogacy. “I have a surrogate’s father-in-law and his son who think that IVF is immoral and the surrogate has to sleep with someone else,” she said. However, as Dr Patel observes, attitudes have changed and society has started accepting surrogacy. “Now men are coming to me and saying, ‘my wife

wants to be a surrogate too’.” Dr Patel, whom many fertility experts credit for bringing India’s reproductive industry to worldwide prominence, oversaw the rise in Gujarati women renting out their wombs over the past six years. “In 2003, I could not find one surrogate. In 2005, I had just 18. But in 2008, I have 175 surrogates with me,” said Dr Patel. Initially, doctors placed advertisements on newspapers to recruit surrogates. As news of this get-rich-quick scheme spread, most of the applicants either came forth offering their services or were introduced by others, Dr Patel said. Locals who recommended healthy and financially needy women to the clinic were given a token sum in return.

No laws However, critics of surrogacy lament the lack of legislation in place to regulate the sudden rise in surrogates. Many describe the guidelines discharged by the Indian Council of Medical Research (ICMR), which governs commercial surrogacy, as being full of

loopholes that may lead to exploitative practices as it is implemented without audits by the clinics themselves. Council member of the Federation of Obstetricians and Gynaecologists Society of India, Dr H D Pai expressed his concerns that surrogacy is giving India bad press: “What is being projected is that India is a lawless market — people are getting exploited and foreigners are coming here to hire wombs.” “They should regulate it and fix the amounts so there will be no exploitation,” said Dr Pai. But Mumbai-based lawyer Amit Karkhanis, an expert in medical law, said all these fears are unfounded as surrogacy can only be good for India. “We follow the ICMR guidelines very strictly,” he said. “A 30-year-old woman who is in need of money can sell her body and sell her sex. But it is better that she becomes a surrogate mother. It is a decent and noble way of earning money, plus you make some poor people happy.” Many have also lambasted India for allowing the outsourcing of wombs for cheap. In the United States, surrogate mothers receive between US$15,000

SURROGACY 101 Not everyone’s eligible A childless couple is only allowed to hire a surrogate if the woman: — has no uterus — has had many miscarriages — has failed many IVF attempts — has genital tuberculosis or fibroids — has a cardiac problem — has had a liver or kidney transplant

Who can be a surrogate? According to the Indian Council of Medical Research: — The surrogate should not be more than 45 years old — Should test negative for HIV and Hepatitis B and C — No one can be a surrogate for more than three times — All clinics need to ensure that the women are fit to carry the pregnancy

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Two types of surrogacy 1. GESTATIONAL - Sperms from dad - Eggs from mum or donor other than surrogate

2. TRADITIONAL - Eggs are from the surrogate mother - Surrogate’s egg is then artificially inseminated with sperms from intended parent or donor

(S$22,921) and US$45,000, compared to their Indian counterparts who get about US$6,800 on average. But Dr Nayna Patel passionately rebuffs these allegations. “America is a popular place for Europeans to find surrogates. Why don’t you say that Americans are exploiting surrogacy,” Dr Patel said. “So I say anything that is done by a rich country like America is good, but anything being done by India is not good?” “I’m not bothered because my conscience is clear and my surrogates know what I am doing,” said Dr Patel.

Written contract According to Karkhanis, most surrogate mothers are bound by contract to return the newborn to its intended parents within weeks after delivery. However, there have been documented cases in American courts of surrogates who refused to hand over the babies to the commissioning couple, citing emotional attachment. She said: “When I had to give up the baby, I was heartbroken and I cried.

making the baby:

“But I told myself that the baby is not mine,” she said. Such incidents do not occur in Anand, said Dr Patel, because she only accepts women, like Hansha and Deepa, who already have children of their own. Also, surrogates have to go through intensive medical checkups to ensure that they are physically and mentally fit. Most importantly, said Dr Patel, consent from the surrogates’ husbands and parents take top priority. As a last measure against fraud, the contract also ensures that the fees are paid in instalments, said Dr Patel, to deter surrogate mothers from abortion. For wombs-for-rent like Hansha and Deepa, they are happy that they saw through their pregnancies so that they get their money. “I am happy, I get benefit and people at the other end get benefit also,” Hansha said.

Urban Surrogates Some 450 kilometres south of Anand, the bustling financial hub of Mumbai has seen a sharp rise in the number of clinics

“

What is being projected is that India is a lawless market — people are getting exploited and foreigners are coming here to hire wombs.”

offering surrogacy over the past five years. Founder of Mumbai-based fertility service provider Surrogacy India, Dr Sudhir Ajja said that the industry is opening its doors wider because the detailed laws are about to be cleared through the Indian parliament.

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The couple who wishes to have a child, also called the intended parents, through the surrogate undergo IVF.

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The mother’s eggs and father’s sperms are retrieved and fertilised in the lab. Embryos are then transferred into the uterus of the surrogate.

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The surrogate is given progesterone tablets for 15 days to ready her endometrium (uterus lining). She takes this for three months.

And the baby goes to... — The genetic parents’ name will appear on the birth certificate. The surrogate mother will not be able to stake her claim on the child unless she proves that the agreements made between her and the intended parents (IPs) are invalid. — There is no legislation on surrogacy so only the Indian Contract Act is applied to surrogacy cases. However, only contracts that are against public policy are considered invalid. — There is no national registry on surrogacy thus far. However, a new bill regulating surrogacy (to be passed in parliament in 2009) will ensure that records will have to be kept by clinics and audits will be carried out.

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02

from previous page 01 Deepa, a Brahmin, gets higher payment for her gestational services than women from lower castes. 02 (Left to right) Sharen, 16, with her mother Jyostaben, 40 and siblings Joyl, 14 and Robin, 17. The money her mother earns as a surrogate will help Sharen realize her dream of becoming a teacher; Joyl wants to be a doctor while Robin aspires to be an engineer. 03 (Left to right) Manju, 27, Mangal, 30, Rajeshri, 25 and Rekha, 28, are all expectant surrogate mothers with Surrogacy India, a Mumbai-based fertility service provider. They are closely monitored for the first 15 days of pregnancy and are unable to leave the clinic.

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“Surrogacy is becoming fully legalised and the guidelines are very specific now. Everybody is okay with doing it,” Dr Ajja said. “Initially a lot of doctors are not willing to get involved.” With more clinics vying for customers, surrogacy fees are set at a competitive rate upwards of Rs200,000. “This amount could buy me a small house in Mumbai,” said Mangal, a 29-year-old widow, in her native Marathi. Rent can reach up to Rs1,500 per month and Mangal, a surrogate under Dr Ajja’s charge, struggles each month to pay her dues. “A quarter of my salary goes towards rent. If I have my own place to stay, things will be so much easier,” said Mangal, who earns Rs6,000 a month as a police officer. “I have not told my employers because if they knew, they would give me the sack.”

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Together with Mangal, fellow surrogates in Surrogacy India, Rehka, 27, and Rajeshri, 24, were introduced to surrogacy by a local doctor. “I was shocked when our local doctor said that carrying another person’s child in my stomach was possible without sleeping with another man other than my husband,” Rajeshri said in Marathi. “I told my husband, and initially he said no. But I was able to convince him there is nothing immoral,” Rajeshri said. “We won’t be able to earn this kind of money in years.” “My husband brings home Rs200 a day as a painter,” housewife Rehka said. “During the monsoon season, his income is badly affected.” “If I had a choice or other options to make this kind of money morally, I wouldn’t do surrogacy,” said Rehka.

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Back in Anand’s Akanksha Infertility Clinic, Hansha readies a Taiwanese woman’s forearm for an injection that would help her ovulate. She would gladly rent out her womb one more time, Hansha says, despite potential health risks and the prospect of having to live with fresh scars from another Caesarean section. This time, she wants to buy a house for her little sister and her disabled father and move them out of their tent — a makeshift house with a canvas roof supported by walls built from granite bricks on one side, and rotting wooden A-frames on the other. “I would like to become a surrogate mother again,” Hansha said. “If a good couple is willing to pay good money, I am ready to become a surrogate one more time.” Anisha — a former surrogate mother, has used about half the money she received as a surrogate to buy this auto-rickshaw for her husband.

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SURROGATE HOUSE

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OME 40 kilometres away from Akanksha Infertility Clinic is the city of Nadiad, a rural college township where temperatures in the summer could reach a scorching 45 degrees. Famous for the Dharmasingh Desai Institute of Technology and the Ayurvedic College, Nadiad attracts migrants from all over India. But the hot and dusty town has been attracting a different crowd in the past few years: fertility tourists from all over the world have been coming to Nadiad to pay a visit to a new landmark — the surrogate house. Camouflaged amongst other dull two-storey buildings like itself, the surrogate house lies along a dusty main road near the Western railway track that links Ahmedabad to Mumbai. But the surrogate house, as most people in the area and Anand fondly call it, is not even a house. It is a rented second-storey flat with four rooms and a kitchen. It has electricity and constant water supply; proper metal-framed sliding windows and curtains; and two squat toilets instead of just buckets . A television set sits alone in the living room, with only a wall clock on an adjacent wall for company. A small white ceramic sink juts out awkwardly by the

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side of the living room wall. There are no tables in the entire house. Only plastic chairs dot the concrete floor, which is covered simply by plastic flooring printed with abstract patterns. The rooms are sparse. Everything seems to be hidden behind built-in cupboards, with neatly arranged metalframed beds aligned beside them. It is the occupants, however, that bring this rented flat to life. For they are no ordinary tenants — 16 pregnant surrogates live together in this flat and for nine months they call this flat their home. Rented by Dr Patel, the surrogate house is an essential part of her surrogacy services. To the pragmatic doctor, the house gives her peace of mind: the flat is near a hospital and there is a caretaker who monitors the surrogates round the clock. Food and housework is taken care of. The only catch is that they will not be able to live with their families during the course of their pregnancy. The children and husband can visit though, but only during the day. The surrogate house is a community with all the surrogates feeding off each other for support through their pregnancies and the caretaker, 42-year-old Niermala Oedra, is tasked to ensure that they keep their chins up during their stay at the house. “I treat the surrogate mothers as my daughters and I always ask those around to take care of them in my absence,” said Oedra. “I feel sad whenever one of my daughters leave the surrogate house after delivery. We would get together and cry for the one who leaves the house.” Failure isn’t really an option for the surrogates — they simply have too much riding on the child growing inside them: paying off debts, education funds, autorickshaws or a new house. For the surrogate house is not just a temporary hostel for surrogate mothers, it is a transition to a whole new life.

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01 Lata, 33, sits on her bed at the Nadiad surrogate house. Nearly eight months pregnant, she said she had no problems settling into her temporary home. 02 Children are a common sight at the surrogate house. Husbands and children are not allowed to live at the house due to space constraints but they may visit during the day.

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03/04 Everyday meals are prepared by a cook that has been specially hired for the surrogates but the women often pitch in themselves, whipping up their favourite dishes.

05 The surrogates congregate to pray in front of an altar where framed images of Sikh gurus, Hindu gods and Jesus Christ lean against the back of the wall on the floor. 06 There are a total of four rooms at the surrogate house, which can accommodate around 20 women. The entire house is sparsely decorated, and all the surrogates sleep on metal-framed single beds. One of the surrogates said that she did not know how beds felt like until she came to the surrogate house.

07 Mariaben, 34, in deep prayer. With her baby due in a week, she worries about the delivery but is confident that Dr Nayna Patel would be able to deliver the twin babies she is carrying successfully to its intended parents — a childless South Indian couple.

08 An intended parent checks up on her surrogate. Some intended parents decide to make the trip to Nadiad to visit the surrogates before making the final decision to pursue surrogacy.

10 The surrogates wave goodbye to the intended parents who are making their way back to Anand after their short visit to the surrogate house.

09 Surrogates are normally expected to hand over the newborn to its parents immediately after delivery but many end up taking care of the baby a couple of weeks after giving birth.

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