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Assisted Reproduction

India’s Medical Tourism Industry – A Revealing Perspective

The American Prospect has just posted a fascinating article entitled Childbirth at the Global Crossroads that I highly recommend to anyone considering using a surrogate in India (or anywhere else in the world). Among the highlights:

The auto-rickshaw driver honks his way through the dusty chaos of Anand, Gujarat, India, swerving around motorbikes, grunting trucks, and ancient large-wheeled bullock-carts packed with bags of fodder. Both sides of the street are lined with plastic trash and small piles of garbage on which untethered cows feed. The driver turns off the pavement onto a narrow, pitted dirt road, slows to circumvent a pair of black and white spotted goats, and stops outside a dusty courtyard. To one side stands a modest white building with a sign that reads, in English and Gujarati, “Akanksha Clinic.”

Two dozen dainty Indian women’s sandals, toes pointed forward, are lined along the front porch. For it is with bare feet that one enters a clinic housing what may be the world’s largest group of gestational surrogates — women who rent their wombs to incubate the fertilized eggs from clients from around the globe. Since India declared commercial surrogacy legal in 2002, some 350 assisted reproductive technology (ART) clinics have opened their doors. Surrogacy is now a burgeoning part of India’s medical tourism industry, which is slated to add $2 billion to the nation’s gross domestic product by 2012. Advertisements describe India as a “global doctor” offering First World skill at Third World prices, short waits, privacy, and — important in the case of surrogacy — absence of red tape. To encourage this lucrative trend, the Indian government gives tax breaks to private hospitals treating overseas patients and lowers import duties on medical supplies.

On the motivations for being a surrogate:

I follow a kindly embryologist, Harsha Bhadarka, to an upstairs office of the clinic to talk with two surrogates whom I will call Geeta and Saroj. (Aditya Ghosh, a journalist with the Hindustan Times, has kindly offered to join me.) The room is small, and the two surrogate mothers enter the room nodding shyly. Both live on the second floor of the clinic, but most of its 24 residents live in one of two hostels for the duration of their pregnancy. The women are brought nutritious food on tin trays, injected with iron (a common deficiency), and supervised away from prying in-laws, curious older children, and lonely husbands with whom they are allowed no visits home or sex.

Geeta, a 22-year-old, light-skinned, green-eyed beauty, is the mother of three daughters, one of whom is sitting quietly and wide-eyed on her lap. To be accepted as a surrogate, Akanksha requires a woman to be a healthy, married mother. As one doctor explains, “If she has children of her own, she’ll be less tempted to attach herself to the baby.”

“How did you decide to become a surrogate?” I ask.

“It was my husband’s idea,” Geeta replies. “He makes pav bhaji [a vegetable dish] during the day and serves food in the evening [at a street-side fast-food shop]. He heard about surrogacy from a customer at his shop, a Muslim like us. The man told my husband, ‘It’s a good thing to do,’ and then I came to madam [Dr. Patel] and offered to try. We can’t live on my husband’s earnings, and we had no hope of educating our daughters.”

Geeta says she has only briefly met the parents whose genes her baby carries. “They’re from far away. I don’t know where,” she says. “They’re Caucasian, so the baby will come out white.” The money she has been promised, including a monthly stipend to cover vitamins and medications, is wired to a bank account that Patel has opened in Geeta’s name. “I keep myself from getting too attached,” she says. “Whenever I start to think about the baby inside me, I turn my attention to my own daughter. Here she is.” She bounces the child on her lap. “That way, I manage.”

On the absence of regulations:

Observers fear that a lack of regulation could spark a price war for surrogacy — Thailand underselling India, Cambodia underselling Thailand, and so on — with countries slowly undercutting fees and legal protections for surrogates along the way. It could happen. Right now international surrogacy is a highly complex legal patchwork. Surrogacy is banned in China and much of Europe. It is legal but regulated in New Zealand and Great Britain. Only 17 of the United States have laws on the books; it is legal in Florida and banned in New York.

In India, commercial surrogacy is legal but unregulated, although a 135-page regulatory law, long in the works, will be sent to Parliament later this year. Even if the law is passed, however, some argue it would do little to improve life for women such as Geeta and Saroj. For example, it specifies that the doctor, not the surrogate, has the right to decide on any “fetal reduction” (an abortion). Moreover, most Indian federal laws are considered “advisory” to powerful state governments, and courts — where a failure to enforce such laws might be challenged — are backlogged for years, often decades. Dr. B.N. Chakravarty, the Calcutta-based chair of the surrogacy law drafting committee, says that the growth of the industry is “inevitable,” but it needs regulating. Even if the law were written to protect surrogates and then actually enforced, it would do nothing to address the crushing poverty that often presses Indian women to “choose” surrogacy in the first place.

The entire article is well worth the read.


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