Growing demand for male children, ‘same caste’ surrogates

Unregulated fertility clinics indulge in medical malpractices, including physical and economical exploitation of women, a study has shown.

Shockingly, preference for male children and demand for ‘same caste’ surrogates are prevalent in India.

“Some couples, say about 5 per cent, who come to my clinic demand surrogates from their own caste,” says Nayna Patel, of the Akanksha Fertility Clinic in Anand, Gujarat that has come up as a major centre for surrogacy in India.

“There is a couple from Tamil Nadu who want a surrogate from the same caste. They have been waiting for the past three years and can continue to wait. I do not entertain such requests or ones that require sex determination,” says Ms. Patel.

Ground reports from Bihar suggest that people do make queries on whether it is possible to have eggs or sperms from a person of the same caste.

The Sama report brought out last year suggested that there is lack of standardisation in treatment, including the number of births, gaps between births, cost of drugs and procedures. This variation was found not only across Uttar Pradesh, Tamil Nadu and Orissa, where the study was done, but also among clinics in the same State.

“Construction Conceptions: The Mapping of Assisted Reproductive Technologies in India,” by Sama, a Delhi-based resource group working on gender, health and rights, conducted the study from 2008 to 2010 and is one of the first of its kind, highlighting unethical medical practices and making a case for the regulation of the ART industry. As part of the research, 43 ART providers and 86 women users, who were undergoing Intra Uterine Insemination (IUI), In Vitro Fertilisation (IVF), or Intracytoplasmic Sperm Injection (ICSI), were interviewed. Along with exploring issues of access and regulation, a key objective of this research is to investigate the industry aspects of ARTs in India; this included the interlinkages between ART clinics in metropolitan cities and those in smaller cities and towns.

The study found that side effects of certain procedures, such as ectopic pregnancies, and the potentially fatal Ovarian Hyper Stimulation Syndrome (OHSS) were under-represented to users. Multiple births, which carry serious risks to the health of the mother and the children, were celebrated by clinics as an achievement, and widely advertised.

“When a woman is made to ovulate repeatedly, she is given a heavy dose of hormones which can have an adverse affect on her health. There is a risk to her life at all stages whether it is ovulation or surrogacy. It is like blood and organ donation. We cannot do it repeatedly and needs to be regulated,” says Amar Jesani, a medical practitioner and an expert on medical ethics. He calls for a nationwide debate on whether commercial surrogacy should be allowed at all.

Question of consent

The survey report says the process of obtaining informed consent was treated as a mere formality, with little attention being paid to the content of the consent form. In several instances, no form had been signed, or forms had been signed without being read, or by proxy, the study says. There was no mandatory insurance for women who became surrogates.

Practices like sex selection, multiple embryo implantation and even the inducement of pregnancy in postmenopausal women, are common. Given the present climate for son preference, ARTs have the (unchecked) potential to encourage pronatalist eugenics and attitudes to design one’s own child (preferably male). Though the Preconception and Prenatal Diagnostic Techniques (Prohibition of Sex Selection) Act (1994) 2003 prohibits sex selection before and after conception, and regulates the use of new reproductive technologies, evidence of the use of ARTs for sex selection was found in the research.

Medical tourism

The fertility industry in India is an integral part of the country’s growing medical tourism industry, which experienced 30 per cent growth in 2000 and 15 per cent growth between 2005 and 2010. A study by the Confederation of Indian Industry states that India’s potential in this field is so lucrative that it can become a $2.3 billion business by 2012. According to one estimate (of Research Professor Rupa Chanda, Indian Institute of Management, Bangalore), medical tourism is expected to fetch an impressive $4 trillion on a worldwide scale. As an integral part of the growing medical tourism industry, the fertility industry is slated to bring in additional revenue of $1 billion to $2 billion by 2012. India is also turning into the surrogacy outsourcing capital of the world; commercial surrogacy and egg donor programmes are fast becoming significant services provided by the fertility industry, the Sama report says.

While there is no official data available about the number of fertility clinics, the Indian Council of Medical Research has identified 886 such clinics across the country. However, unconfirmed reports from various sources suggest that at least 50 such clinics are added every year. The ART clinics are not the only players in the business of promoting ‘reproductive tourism’ in India. Other emerging players include a wide array of organisations catering for clientele, both at the national and international level. These range from ART consultants, medical tour operators, surrogacy agents, the hospitality industry, and tourism departments to other organisations specialising in medical tourism promotion.

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