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The Bill, which is now open to public debate, is aimed to regulate this ballooning industry which most industry experts estimated to be worth US$500million. With less paperwork and overall costs as compared to other countries which have legalised surrogacy, India is now the premier destination for childless couples who have exhausted every visible option of having their own children.

Nonetheless, the impending introduction of the Bill has been a widely debated topic among medical practitioners, lawmakers and fertility tourists from all over the world. Proponents of the Bill say that it will help regulate and monitor (through the National Advisory Board for Assisted Reproductive Technology) fertility clinics which support surrogacy programs, weeding out uncertified fertility practitioners who lack quality control and underpay their surrogates.

Others say that a law governing the surrogacy industry will also boost reproductive tourism and formalize the legality of the practice that has, up until the Supreme Court case of 2008, been guided by guidelines by the Indian Council of Medical Research (IMR) since its inception in 2002. The Supreme Court case in 2008, which ruled on the case of a Japanese surrogate baby who was legally unable to leave India after its parents divorced shortly before delivery, set in motion a sharp revision of the ICMR guidelines that critics condemned as being full of loopholes.

The biggest attack on surrogacy, however, lies outside the quasi-legal framework (the ICMR guidelines) that has been supporting it since 2002. Human rights activists, conservative fertility doctors, lawyers and government officials have spoken out on the ethical considerations that the surrogacy industry has fashioned: Exploitation and under-compensation of poor women, the authorizing of homosexual parenthood, the lack of proper audits and even the undermining of Indian medical professionalism have been expressed in various media outlets.

The Indian Surrogate is a firsthand look into the issues that has enveloped the industry. More importantly, this package aims to provide a better understanding of the people – doctors, surrogate parents, fertility tourists and the surrogates – that built up this controversial industry.

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.

Seven 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 the surrogate mother 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 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 Intra-Uterine Insemination (IUI) and three In-Vitro Fertilisation (IVF) attempts, the couple decided to turn to surrogacy as a 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, doctors say around 500 to 600 surrogate babies could be born throughout the world each year, with about 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, industry experts estimate the industry to be worth US$445 million, with around 200 clinics documented across India offering surrogacy services. Non-Governmental Organisations (NGOs), however, speculate that the number of clinics could be as high as 3000.

Intended parents are charged around US$20,000 for the entire surrogacy process — from initial consultation, 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 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 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.

At its conclusion, Manji’s case 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 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 will also make it compulsory for foreigners seeking surrogacy services in India to provide documentary proof that they would be 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, 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 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.”

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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

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

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

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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.

Earning 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.

Hansha also has to provide for her 15-year-old little sister and 57-year-old 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, measuring the height and weight of patients, checking 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 three-room 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

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 Deepa. “They do not mind paying a higher 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.

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Credited as the pioneer to commercialised surrogacy, Dr Nayna Patel has put the humble Gujarat town of Anand on the world map. At the same time, she has been criticised for exploiting women as wombs-for-hire.

In Dr Nayna Patel’s office at her clinic in Anand, Gujarat, a makeshift altar is created in a shelf beside her desk, devoted to many gods and deities from all religions.

She has a Christian crucifix placed in the middle, alongside some figurines of Hindu gods; a small picture of guru Sai Baba pasted on the wall and, beside it, a framed photo of founding father Mahatma Gandhi.

“I believe in all religions. It gives me spiritual calm and strength,” Dr Patel said.

In most Anand households, it is commonplace to see at least one of these saintly figures on the altar. But sometimes, one would find Dr Patel’s picture strewn alongside. These is done by women who revere the doctor so much they literally place her on a pedestal.

“I feel really bad about it but you can understand what they must have gone through to give me that respect,” Dr Patel said.

The 49-year-old doctor has seen her fair share of women who have gone through poverty and anguish. She recalled an Indian couple in their 30s and their dramatic suicide attempt. They wanted to kill themselves with poison but the bottle slipped from their fingers while they were crossing the train tracks.

With their mind set on death, they had wanted to end their lives by standing in front of a speeding train, leaving their three children at home. But the suicidal couple decided to have one last meal — rice packed in a piece of newspaper — before they die.

In a strange twist of fate, they chanced upon a recruitment advertisement placed by Dr Patel as they finished their rice. The mother became a surrogate and that gave the couple and their three kids a new lease of life.

Over the past six years, Dr Patel’s Akanksha Infertility Clinic has bestowed gifts upon many women.

For women who cannot conceive naturally, they receive the gift of a new life: a baby nurtured and delivered from an Indian surrogate mother.

And for poor Indian women, it is the chance to escape poverty by renting their wombs to infertile married couples for a large sum of money.

Former surrogate mother Hansha was one of those women under Dr Patel’s charge. The 39-year-old received a huge fee — 83 times her monthly salary — for her gestational services.

“Madame (Dr Patel) is like god to us. She helps us a lot,” said Hansha in her native tongue Gujarati. She gave birth to twins, a boy and a girl, to a couple from the United States.

For her work with women, this fertility expert has been lauded by many people and singled out by fellow medical practitioners as the driving force behind commercialised surrogacy.

Mumbai-based Dr Yashodhara Mhatre praised the doctor for giving her the “courage” needed to pursue surrogacy and help other women.

“It’s only because of her (Dr Patel) that we are able to do this,” Dr Mhatre said. She has her own business in India’s financial capital, aimed at providing surrogacy services to foreign couples.

“If she can do it in a place like Anand and take care of foreigners and put everything together…there is no reason why we can’t,” said Dr Mhatre.

Even American talkshow host Oprah Winfrey was impressed and sent a film crew down to Dr Patel’s clinic to shoot a feature on her work on surrogacy.

That particular episode was titled “Wombs for Rent” and it turned out to be a milestone in Dr Patel’s career. “That was my proudest moment,” she declared.

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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.

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 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 metal-framed 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 are 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 is not an option for the surrogates — they simply have too much riding on the child growing inside them: paying off debts, education funds, auto- rickshaws 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.

In the fast-paced financial capital of Mumbai, one surrogacy clinic has turned itself into a one-stop shop for customers to enjoy a no-frills holiday and get a baby out of it.

To many foreign couples who have decided on India to solve their baby woes, the rough and tumble experience while going through the surrogacy process could prove to be a highly stressful one.

In order to ease the culture shock and emotional distress, a Mumbai-based organisation is offering travel packages to its clients, its founders said, that covers airfare, lodging and most importantly, a baby.

Surrogacy India is the first-of-its-kind fertility service provider in the country, claims its founder Dr Sudhir Ajja, providing “group tours” that handle the needs of every couple that wants to rent a womb.

“From the time they get down at the airport to the time they go back, we give them a fixed price and it covers anything that you can imagine,” Dr Ajja said.

Each package costs around US$20,000 (S$30,944) and includes items like plane tickets, accomodation, transportation, a surrogate mother and three cycles of In-Vitro Fertilisation (IVF) and the money is paid in instalments. The surrogate mother gets about US$4,500.

More importantly, co-founder Dr Yashodhara Mhatre believes the all-encompassing package sets her clients’ mind at ease by lessening the stress of the surrogacy treatment, from the moment they arrive at the world’s second-most populous nation.

“They (clients) are…very apprehensive about India because it already has a ‘Third World’ tag attached to it.” Dr Mhatre said. “We wanted to make the journey much more comfortable for the patient…by telling them where to stay, where to eat, what to eat, and so on.”

The organisation was started three years ago in India’s financial capital and business has picked up in the last year. By the end of 2008, Surrogacy India has delivered 10 babies to its clients, Dr Ajja said, with a success rate of 35 percent.

Through its website — surrogacyindia.com — Dr Mhatre and Dr Ajja link up and exchange information with foreign couples. They even set up video conferences between clients and potential surrogate candidates before jetting the intended parents down.

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