The Health Ministry guidelines on the regulation of ART clinics fail to address the issue of breast feeding for surrogate children.

Childless couples from all over the world bring home babies with help from India’s mushrooming Assisted Reproductive Technology (ART) centres. But in their haste to hold their babies in their arms, commissioning parents tend to overlook the infant’s need for mother’s milk, despite the fact that is has been scientifically established that mother’s milk is a critical source of nutrition for the infant.

A recent report of The New York Times quotes an online study, which after comparing babies who received formula with breastfed infants noted increased development in the white matter regions of the brain, including areas associated with planning, social and emotional functioning, motor ability and language. Also, prominent advertisements put out by the Ministry of Women and Child Development clearly recommends “only mother’s milk for the first six months”.

It is, therefore, surprising and disturbing, to note that the Health Ministry guidelines on the regulation of ART clinics do not address the issue of breast feeding for surrogate children. Dr R.S. Sharma, Deputy Director General, Indian Council of Medical Research (ICMR) and Member Secretary of the drafting committee of the Assisted Reproductive Technology (Regulation) Bill agrees the concern needs to be addressed.

He points out that India's surrogacy industry is presently governed by the Health Ministry approved National Guidelines for Accreditation, Supervision and Regulation of ART clinics, 2005. “As of now, these guidelines do not address the issue of breastfeeding for children born out of surrogacy but once the ART (Regulation) Bill is passed, the Central government will be empowered to frame rules and address the issue of breastfeeding," he observes.

A NOIDA-based couple, who recently brought home a surrogate girl child of 30 days, had the infant breast-fed by the surrogate mother for three weeks. After that they were advised to switch to formula. According to them the child is doing well.

Dr Shivani Gour, whose South Delhi clinic has to its credit 600 surrogate deliveries over the last four years, says, “These children do not get breast milk from the surrogate mother as she is recovering from the pregnancy and does not usually want to breastfeed. Breastfeeding is definitely ideal, but one has to be reasonable. Most babies get top feeds but in cases where the biological mother is keen to breastfeed, lactation can be induced. What is required is a long term study, with paediatricians on board, to follow up on the surrogate baby’s health status.”

Dr Arun Gupta, Coordinator of the Breastfeeding Promotion Network of India and a member of the Prime Minister’s Council on India’s Nutrition Challenges, is not happy with the increasing reliance on infant milk substitutes. “We are following faulty infant feeding practices. Of the 26 million babies born in India every year, 20 million aren’t able to get optimal feeding. This is part of the same problem – both doctors and the public have lost sight of the value of breastfeeding. They have been led to believe that artificial infant feeding practices are as good as breastfeeding. This is certainly not the case,” he argues.

Dr Gupta recommends the establishment of human milk banks and cites the example of Brazil, which has thousands of such banks where women volunteer milk donations. Delhi-based clinical nutritionist, Ishi Khosla, agrees, “While surrogacy may be changing the world for many parents, the long term health of the child requires that arrangements be made for breastfeeding. Unless the woman is not lactating, it is not a good enough reason to deny mother’s milk to a child.”

Today, with better testing and refrigeration facilities, the milk bank option is growing popular. Behind this intense debate are promising exceptions like Ms TRC (as she chose to be named), a 34-year-old American woman, who has ensured that her son born from surrogacy in India gets exclusive breast milk for a year.

Her first donor was a friend, who introduced her to a social web group where she posted a request for milk donors. “The response was overwhelming and I now had enough donors to exclusively breastfeed my son. Two of the donors were even able to provide colostrum and transitional milk,” she says.

Ms TRC had initially even considered inducing lactation with hormones, but was advised against it by her endocrinologist, who said that the benefits of breast milk did not outweigh the risk to her health that the procedure – which required the administration of continued synthetic hormones – entailed.