THE BABY FAC­TORY

In­dia's sur­ro­gacy nurs­ery which pro­duces ba­bies for the world

India Today - - FRONT PAGE - Pho­to­graphs by RO­HIT CHAWLA Text by GAY­A­TRI JAYARAMAN

In a cramped by­lane off Sta­tion Road in Anand, men camp be­neath the banyan tree, or perch on a bench wait­ing for their women to com­plete their busi­ness at an ad­ja­cent clinic. For­eign­ers and In­di­ans, all cou­ples, are dropped off by taxis at the en­trance, hus­bands hold­ing wives by the hand. In­dia’s co­op­er­a­tive milk cap­i­tal has also turned into its sur­ro­gacy hub: The Sat Kaival Hos­pi­tal and Akanksha In­fer­til­ity Clinic run by Dr Nayana Pa­tel, 55, and her hus­band Hitesh, 57, churns out 30 ba­bies on aver­age ev­ery month.

Sur­ro­gate No. 500, a 28- year- old sin­gle mother of two, de­liv­ered a baby girl here on Au­gust 5, an in­ad­ver­tent mile­stone in the now rou­tine com­ings and go­ings of co­op­er­a­tive com­merce. Four days later, she sees the baby for the first time at the be­hest of the spon­sor­ing par­ents, who are from Lucknow. She does not recog­nise the new­born from a se­ries of pho­to­graphs. “If it’s a girl, it must be mine,” she says, blankly.

A year ago, she had noth­ing. Her younger son is three and her older one five. Aban­doned by her hus­band at the younger child’s birth, she moved in with her mother, a do­mes­tic worker who lives on the road be­hind Dr Pa­tel’s home. She earned Rs 2,000 a month do­ing house­work. A friend

brought her to the doc­tor. She has not seen her chil­dren even once since. “I can build my own house now,” Sur­ro­gate No. 500 says. She would not do this again, she adds. But Rs 3 lakh goes a long way in Anand, Gu­jarat.

Ev­ery turn on a road in Anand bears jagged sig­ni­fiers of a town­ship strain­ing to­wards moder­nity. A char­iot ven­dor is down the road from a gun store. Past the Sub­way fran­chise is the manda­tory Amul out­let, sell­ing shrikhand and the lo­cal mithai kaju ka­tri from the 6.5 mil­lion kg- a- day co­op­er­a­tive milk union move­ment launched here in 1946 by Vergh­ese Kurien. While the world knows Anand, a town of 1.8 mil­lion, for the White Rev­o­lu­tion, many other rev­o­lu­tions have since jos­tled for space here. There are 66 higher ed­u­ca­tion in­sti­tutes and two uni­ver­si­ties. The town is also an in­dus­trial en­gi­neer­ing and emerg­ing ship- build­ing hub boom­ing with the open­ing of the Khamb­hat port nearby. But it is hos­pi­tals, the Shankara Eye Hos­pi­tal, the spank­ing new Zy­dus multi- spe­cial­ity fa­cil­ity on the city out­skirts and the mul­ti­tude of med­i­cal agen­cies pharmacies, pri­vate nurs­ing homes and clin­ics that drive its med­i­cal tourism. You won’t find it men­tioned in the ‘ Vi­brant Gu­jarat’ roadmap for Anand dis­trict but as far as co­op­er­a­tive move­ments go, the town of­fers up the mother of them all: Sur­ro­gacy.

In 2001, Dr Pa­tel, who had been dabbling in in- vitro fer­til­i­sa­tion ( IVF) preg­nan­cies since 1999, took on a stray case of sur­ro­gacy for an NRI fam­ily in which the grand­mother fa­mously moth­ered the child to save her daugh­ter’s mar­riage. Fea­tured on the

ONE WITH HER OWN

SU­MAN ( SEC­OND FROM LEFT), 32, CUR­RENTLY CAR­RY­ING TWO SUR­RO­GATE BA­BIES IN HER WOMB, WITH HER DAUGH­TERS NIDDHI, 7, NISHA, 9, AND NI­RALI, 11, HUS­BAND MA­HEN­DRA, AND MOTHER SARITHABEN IN MEHRAU VIL­LAGE, GU­JARAT

Oprah Win­frey show in 2006, she has al­most be­come an in­sti­tu­tion, in­stru­men­tal in all land­mark cases in­volv­ing sur­ro­gacy up un­til now. The In­dian Coun­cil of Med­i­cal Re­search drew up sur­ro­gacy guide­lines based on Dr Pa­tel’s 2001 NRI grand­mother case and sub­se­quent cases. She hit the head­lines in 2008 when the cus­tody of Manji Ya­mada, a baby born to Ja­panese par­ents at Dr Pa­tel’s fa­cil­ity in Anand, was thrown into am­bi­gu­ity af­ter they sep­a­rated be­fore his birth. The land­mark Jan Balaz vs Union of In­dia case, also in­volv­ing Dr Pa­tel’s clinic, saw In­dian cit­i­zen­ship be­ing con­ferred on the twin ba­bies and the due process of adop­tion fol­lowed. Th­ese pi­o­neer­ing cases con­ferred the sur­ro­gacy cap­i­tal sta­tus on Anand.

The num­ber of ba­bies de­liv­ered at Dr Pa­tel’s clinic is 680 and count­ing. But a new draft bill in the mak­ing could re­move sur­ro­gates from di­rect em­ploy­ment with the fer­til­ity clinic and put them un­der the in­flu­ence of a sur­ro­gate agency. Key fea­tures of the bill in­clude:

Sur­ro­gates must be in the age bracket 21- 35.

No sur­ro­gate should un­dergo im­plan­ta­tion cy­cles more than three times for a cou­ple.

If mar­ried, a sur­ro­gate should re­ceive con­sent of her Only In­dian cit­i­zens can be con­sid­ered for sur­ro­gacy.

Sur­ro­gate mother must re­lin­quish all fil­ial rights over child.

Par­ents must ac­cept the child born of the sur­ro­gacy.

IVF will be sep­a­rated from sur­ro­gacy re­quire­ments, which will be out­sourced to spe­cialised agents. Dr Pa­tel wishes the Govern­ment en­gaged more with sur­ro­gates and doc­tors at the lo­cal level. “The Govern­ment is say­ing it will trust an agent, who may or may not be ed­u­cated or hu­mane to­wards sur­ro­gates, but not doc­tors. Why?” she asks.

“I won­der some­times, if there were two chil­dren, a girl and a boy, and they didn’t want the boy, could I take him home?” says Su­man, 32, six months preg­nant and car­ry­ing twins. She was im­preg­nated with quadruplets and two were ter­mi­nated. She hasn’t been home in five months though her three daugh­ters, Niddhi, 7, Nisha, 9, and Ni­rali, 11, visit her of­ten. Su­man is car­ry­ing plas­tic dolls she bought for them from the mar­ket to­day. The Eid fes­tive air is ac­cen­tu­ated at Mehrau vil­lage, 11 km from Anand, as vil­lagers come out to wave, cheer and ask Su­man how her preg­nancy is go­ing. Only one home in the vil­lage, that of a lawyer cou­ple, re­fuses to par­tic­i­pate. “Are the peo­ple who talk go­ing to put food on my plate? I have not done any­thing wrong, so what is there to hide?” Su­man asks as her chil­dren clam­ber all over her. She needs the money. Her hus­band earns Rs 100 a day as a labourer in the nearby fields.

Dr Pa­tel has fought vary­ing lev­els of so­cial op­po­si­tion since 2005, when she be­gan her sur­ro­gacy pro­gramme. A third of the chil­dren born here have gone to In­dian cou­ples, an­other third to NRIs and the oth­ers to for­eign­ers from over 34 dif­fer­ent coun­tries. All sur­ro­gates in the clinic are be­low 35 and mothers to at least one child of their own. They are re­quired to meet min­i­mum health re­quire­ments or are oth­er­wise “nu­tri­tion­ally for­ti­fied”. The hus­band’s con­sent is manda­tory in case of cou­ples.

Dr Pa­tel is now build­ing a 100,000 sq ft hos­pi­tal on the out­skirts of the city that will ac­com­mo­date would- be par­ents, sur­ro­gates, IVF fa­cil­i­ties and neona­tal units next to a vo­ca­tional in­sti­tute. While that is slated for a March 2014 launch, for now she must flit be­tween Sur­ro­gate House, the des­ig­nated home for sur­ro­gate moms, mul­ti­ple hos­pi­tals, stand­alone neona­tal units, and her clinic. Since her first IVF case in 1999 that yielded baby Akanksha, af­ter whom the clinic is named, Dr Pa­tel has been a life- giv­ing, fam­ily- sav­ing bene­fac­tor. It is in her genes: Her late mother, a so­cial worker and cor­po­ra­tor in Ra­jkot in the 1950s, was her­self a fierce ad­vo­cate of women’s rights.

At the clinic, a jet- lagged Por­tuguese- speak­ing cou­ple from An­gola, the sec­ond to ar­rive here from that coun­try, ner­vously alights from a car. The woman, 34, lean, beau­ti­ful, her face strained with emo­tion, has just lost her baby and her uterus to com­pli­ca­tions. “Can we use more than

one sur­ro­gate?” she asks, in halt­ing English. At the door is Ta­jima, a 34year- old Ja­panese woman who lost her uterus to nu­clear ra­di­a­tion- linked can­cer a few years ago. Her baby had just been born the pre­vi­ous day and is in neona­tal ICU at Zy­dus hos­pi­tal. That evening, Dr Jagdish Prasad, the di­rec­tor gen­eral of health ser­vices, has cir­cu­lated a Cabi­net note on the As­sisted Re­pro­duc­tive Tech­nol­ogy ( Reg­u­la­tion) Bill an­nounc­ing a firm in­ten­tion to dis­al­low sur­ro­gacy for for­eign­ers, on the back of the Min­istry of Home Af­fairs al­ready ban­ning same- sex cou­ples and sin­gle par­ents of for­eign ori­gin. At Akanksha clinic, prospec­tive par­ents, with their heads bent over re­ports, med­i­ca­tion and bills, ig­nore the news flash­ing on five LCD screens.

Sur­ro­gate House is a com­plex of two two- sto­ried bun­ga­lows. It’s Eid, Au­gust 9, and a baby shower is un­der­way at 11 a. m. The ‘ par­ties’ of Aarti, 31, Gita, 29, and Ruk­mini, 27, all seven months preg­nant, have sent them saris, and shared the cost of the cer­e­mony. The women don make- up and braid their hair as they slip into their new saris, stolen plea­sures that bring home the re­al­ity of a preg­nancy that is not quite theirs. Durga, 29, smiles. “It’s our child, we call it our child.” Ruk­mini has more rea­sons for joy. Her di­a­mond- washer hus­band has just in­au­gu­rated his own store that morn­ing. When she re­turns, she will open her own beauty par­lour.

Hous­ing for sur­ro­gates has of­ten been crit­i­cised as glo­ri­fied forced iso­la­tion but Dr Pa­tel’s stance is that it guar­an­tees the health of both mother and child. Many sur­ro­gates say they pre­fer it. It al­lows them anonymity from pry­ing neigh­bours or rel­a­tives. The con­trolled en­vi­ron­ment pro­vides them with nu­tri­tional food and the chance to en­rol in vo­ca­tional classes, from choco­late- mak­ing to com­put­ers,

em­broi­dery and hair and make- up.

Sur­ro­gate mothers say the base rate that ac­crues to them from bear­ing ba­bies, be it for In­dian par­ents or for­eign­ers, is around one- fourth of the to­tal cost of Rs 8- 11 lakh that clin­ics charge. What dif­fers though, is how they are treated. In­dian par­ents rarely en­cour­age an en­gage­ment with the sur­ro­gate af­ter birth.

In­side a room on the ground floor of Sur­ro­gate House, Suresh, a 28year- old au­torick­shaw driver from Ahmed­abad, has cooked rice for his wife See­tal, 26, preg­nant with her first sur­ro­gate child. Their own two chil­dren, aged 7 and 11, are in board­ing school. They want to buy a house with the Rs 4 lakh from the sur­ro­gacy. He un­der­stands, he says, that the child is not his, but has trou­ble not feel­ing af­fec­tion for it. He ca­resses his wife’s stom­ach af­fec­tion­ately.

Lo­cal Methodist and Catholic churches, maul­vis and priests have all preached against sur­ro­gacy to their re­spec­tive con­gre­ga­tions. In vain. “It used to be much harder when I started. Now I don’t fight be­cause I know no one who is talk­ing is go­ing to give th­ese par­ents a child or save th­ese sur­ro­gates from their poverty,” says Dr Pa­tel.

Sur­ro­gates keep com­ing back be­cause the money counts. Kaushal, 37, has three chil­dren and works as a cook now, earn­ing Rs 2,000 a month. Her small re­built home in Anand has a light and fan in the hall, and a tele­vi­sion with a ca­ble con­nec­tion. But there are no bulbs in the in­ner room or the kitchen. Most of the money she earned through her two sur­ro­ga­cies since 2007 went into un­suc­cess­fully treat­ing her al­co­holic hus­band’s cir­rho­sis and heart con­di­tion com­pli­cated by di­a­betes. A de­vout Catholic, her parish and the home she works in would both dis­miss her if they found out what she had done, she fears. But thanks to the ba­bies she car­ried, she doesn’t need their ap­proval to put a roof over her head. She can look God in the eye be­cause she knows she hasn’t done any­thing wrong. The rest, she says, she will man­age.

MILE­STONE MOM

SUR­RO­GATE MOM NO. 500, AND THE 680TH CHILD BORN ATTHE SAT KAIVAL HOS­PI­TAL IN ANAND

DOC­TOR LIFE ATWORK

DR NAYANAPATEL( RIGHT), 55, AS­SISTED BYDR HARSHAVHADARKA, 36, PLACES AN EM­BRYO TO MARK­THE START OFASURROGACYCYCLE

IN THE NAME OFGOD

( FROM LEFT) SUR­RO­GATE MOTHERS MAD­HURI SURBHI PA­TEL, 24, NI­RAN­JANA SARLA PA­TEL, 28, AND RUK­MINI REDDY, 27, HAVE ASREEMANTHAM OR SEV­ENTH MONTH CEREMONIALBLESSING PER­FORMED JOINTLYATTHE SUR­RO­GATE HOUSE

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