Sunday Anchor

They need the baby, she needs the money

Rahi Gaikwad reports from Anand

Sitting on the floor of her tiny two-room set located in a mill hutment in Gujarat’s Anand district, Mayaben, 40, wonders if she could get pregnant again for money. Since 2007, when she first became a surrogate and earned Rs. 2.5 lakh, the compensation has nearly doubled, but the age bar has been lowered.

“I do not have a good job or income,” her husband says. “While we have saved that money, we need more for the children’s education; for this house.”

In Ahmedabad’s Maninagar area, housewife Taraben has kept her trip to Anand, a surrogacy hub, under wraps. “My neighbours frown upon it,” she says.

Anand owes its reputation as India’s surrogacy capital to Nayana Patel, who runs the Akanksha Infertility Clinic. She first shot to fame in 2004, for performing the delivery of a surrogate grandmother.

“People think it’s a lucrative business, but it is a life-changing procedure for the couple,” Dr. Patel says denying the view that surrogacy has descended into a baby-making industry.

A surrogate makes anywhere between Rs. 3-5 lakh per pregnancy, depending on the commissioning parents, while the total cost of “making a baby” is roughly Rs. 10 lakh.

A group of expecting surrogate mothers are lazing the afternoon away on a row of beds at Akanksha’s residential facility.

For many surrogates, the clinic’s accommodation is a convenient hideout from disapproving family members and village elders. “When the bump starts to show, we come here. In the village, they say we are going to sell the baby,” says another expecting surrogate.

The scale of ART services has increased over a decade creating a higher demand for surrogates. At Dr. Himanshu Bavishi’s Bavishi Fertility Clinic, cases have gone up ten-fold from 1999, when ART was performed in his clinic. However, he points out that surrogacy forms only a small part of the overall fertility treatments.

“People say IVF [in-vitro fertilisation] clinics make a lot of money. That is not true. By our estimate, not more than 5,000 babies have been born through surrogacy in India in the past decade,” says Dr. Bavishi, who is the president of the Indian Society for Third-Party Assisted Reproduction (INSTAR).

“It is a lucrative business for everybody,” says Girish Nigudkar, CEO, Intermedics, supplier of IVF equipment. “Both doctors and surrogate mothers get paid well, but the growth is coming from IVF, not surrogacy alone. While there was a boom in surrogacy cases in the past five years, new regulations are likely to stabilise it.”

From 2004, Dr. Patel has helped deliver 826 babies by 619 surrogates, most of them commissioned by foreign nationals.

U.S. citizen Steve, who recently got a baby boy, found getting a surrogate child unviable in his country owing to legal and regulatory issues. Also what would have cost him $100,000 to $150,000 there cost him about $50,000 in Anand.

Breaking taboos

Swathi V. reports from Hyderabad:

That modernity tramples over traditional taboos is proven by the fact that none of the family members, even in-laws, of the surrogates interviewed in Hyderabad objected to their decision as long as it brought returns.

Though no official statistics are available, doctors dealing with surrogacy cases vouch for the fact that Hyderabad has become a thriving business centre for the “baby-making” industry, be it surrogacy, IVF, or oocyte donations.

“In future, there will come a time when single men or women will choose to have a surrogate child,” says M. Divakar Reddy, who runs the Dr. Padmaja Fertility Centre, where his wife, P. Padmaja Reddy, attends many surrogate pregnancies.

He is one of the few in the city who runs a shelter home in Bhongir for the surrogate mothers to stay from the preparatory stage to delivery. As of now, his home has more than 100 surrogate mothers, whether carrying, in preparatory stage or under observation.

Over three years, Dr. Reddy has delivered 178 babies from some 130 surrogate deliveries. As of now, 40 couples are still in waiting.

Some other doctors like K. Anuradha of the Anu Test Tube Baby Centre do not take up surrogacy as a mission, but do not flinch from offering surrogacy advice.

“As per ICMR guidelines, doctors should keep away from the surrogacy chain and limit themselves to advising couples,” she says.

Aspiring surrogate mothers are flocking to the city from places such as Rajahmundry, Srikakakulam, Mahabubnagar, West Godavari and Visakhapatnam.

The Greater Hyderabad Municipal Corporation, however, does not recognise surrogacy for issue of birth certificate. Hospitals often get requests for registering the name of the genetic mother, rather than the surrogate mother. However, in such cases, if the surrogate mother develops complications and dies on the table (surrogate deliveries are often caesareans, for fear of complications), the doctor would be in a fix as the death certificate cannot be issued for the surrogate. To circumvent such difficulties, couples are following legal adoption procedures after delivery, Dr. Anuradha says.

NRI and non-Indian commissioning couples often encounter visa problems for their little ones, as many countries do not have any rule on surrogate children as yet.

“As per ICMR guidelines regarding surrogacy, foreigners who travel here for surrogate children should obtain a medical visa and register at the Foreigner Regional Registration Office. But the guidelines are not binding on the clinics,” Dr. Anuradha says.

Designer baby fad

Vinaya Deshpande reports from Mumbai:

Adi Irani, a 60-year-old ART agent for 13 years said, “Earlier, I used to get clients from big cities such as Mumbai and Delhi. But now I get calls from all over the country. I travel to Nasik, Pune, Chandigarh, Raipur, Chennai, Amritsar, Lucknow to provide egg donors the recipients’ specifications. They want certain criteria fulfilled, such as religion, height, looks, education. If I get them a donor of their specification, they are willing to pay as much as Rs. 1 lakh.”

While a few leading doctors in the city deny that the industry was moving towards providing “designer babies,” they agree that recipient parents demand that the egg donors resemble their physical characteristics. Firuza Parikh, Director of the Department of Assisted Reproduction and Genetics at Jaslok Hospital, says: “Parents don’t ask for designer babies, but they want us to make sure that the egg donor resembles them in profile.”

But agents say the “resemblance in profile” factor is stretched too far. “An egg donor with Mongolian-Caucasian looks earns Rs. 1 lakh straight for one round. The cost varies with educational qualification, height and eye colour of the egg donor,” Mr. Irani says.

Generally, an egg donor earns anything between Rs. 25,000 and Rs. 1 lakh. Sources say an egg donor taller than 5 feet 8 inches earns Rs. 10,000 extra. If her complexion is as “fair as milk,” the cheque goes up by Rs. 50,000.

“People want Jain egg donors or Muslim surrogates. They are not willing to compromise on religion and caste factor,” says an agent. Despite the national guidelines directing the protection of identity of the women, their photographs and personal details are openly shared by the agents and the hospitals. The correspondent was shown medical files from reputable hospitals across the country having photographs of the surrogates in case files of the genetic parents.

Mumbai sees a lot of footfall from foreigners for surrogate babies. Mainly, citizens from Australia, the U.S. and Scandinavian countries flock to the city.

In Mumbai, recipient couples or genetic parents pay anything between Rs. 12-15 lakh for one surrogacy. The surrogate mother earns Rs. 3-4.5 lakh. “But there is rampant fleecing, especially if the surrogate mother is carrying twins. Ideally, if the doctors charge double for twins, then the surrogate mother too should earn double. But she gets only Rs. 25,000 extra. She should get at least 50 per cent more,” Mr. Irani says.

“Doctors don’t see if the surrogate is capable of carrying twins. Many times, thin and underweight women carry twin pregnancies, and then deliver prematurely. The babies die in the incubators 15-20 days after delivery. All this because the doctors didn’t bother to follow the surrogate screening criteria,” Mr. Irani says.

Many industry insiders say the doctors do not check the age and other important details of the egg donor or surrogates. One of two cases in the country where a teenaged egg donor died allegedly from doctor’s negligence happened at a reputable hospital in Mumbai.

Sanjay Gupte, member of a watchdog committee recently appointed by the Maharashtra Medical Council to issue guidelines for curbing malpractices in the field, says he has submitted the draft guidelines. “We have recommended a nine-member standing committee to address this issue in the State. It will have a patient representative, an IVF specialist and an NGO representative among its members,” he says.

Unhappy experiences

R. Sujatha reports from Chennai:

Sumathi and Anandhi of Vyasarpadi in north Chennai have had unhappy experiences as surrogate mothers. While Ms. Anandhi received Rs. 2 lakh, Ms. Sumathi was paid Rs. 1 lakh though she was promised more. “The broker, also a surrogate mother, cheated me of my money,” Ms. Sumathi says.

They are currently members of an organisation called GSMART (Global Surrogate Mothers Advancing Right Trust). Though its chairman, A.J. Hariharan, says surrogate mothers are better protected now as contracts are drawn up — specimen contracts available online show no cover for medical risks during pregnancy.

Hari G. Ramasubramanian, chief consultant at Indian Surrogacy Law Centre, Chennai, says that since the surrogate mother and her family are given sufficient medical and psychological counselling, the risks are minimised. “The basic principle of insurance looks at ART as a voluntary act with commercial interest” and hence getting insurance cover is tough, he adds.

The medical equipment industry has also spurred growth, says P.M. Gopinath, former Director of the Government Kasturba Gandhi Hospital for Women and Children. “The market potential is high as infertility in the population is high and they know they will get a share. Fertility treatment is now patient-driven, doctor-driven and industry-driven,” Dr. Gopinath says.

Despite commercialisation of the industry, government hospitals have not come forward with fertility services. Dr. Gopinath says lack of dedicated specialists and fear of malpractice has deterred the government.

(Names have been changed)

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