India reins in surrogacy services for foreigners
THANE, India — Long before she married, at 14, Sushila Sunar had stopped going to school. She never learned to read. After her two children were born, she broke rocks at a construction site for a few dollars a day, the only work she could find.
Then a woman approached Sunar with a job that paid nearly $6,000, a sum so large she and her husband felt she could not refuse. She became a surrogate mother, delivering a light-skinned baby for a foreign couple she never met.
Three years later, with her own children’s school bills piling up, she has decided to become a surrogate for a second time.
“I didn’t study; I can’t do any other work,” said Sunar, now 28 and six months pregnant. “This is my only option to make a living.”
Chasing dreams of financial independence, thousands of poor Indian women have found work as surrogate mothers, helping to turn this country into a favored destination for foreign couples who can’t become pregnant on their own.
Now India’s government is taking the first significant steps to rein in commercial surrogacy, citing fears that the women are being exploited by a mushrooming industry that pays them a fraction of what surrogates earn in the West.
In October, authorities barred foreign couples from hiring Indian surrogates, following an earlier ban prohibiting single people and gays from contracting with Indian surrogates. The government has proposed a law allowing surrogacy only for married Indian couples, or those recognized by the government as being of Indian origin.
The new legislation, which has yet to be taken up in Parliament, also would prevent women from becoming surrogates multiple times, or after they pass age 35.
India’s low medical costs, lack of regulation and large numbers of women willing to carry someone else’s child have long fueled concerns about corruption and malpractice by doctors eager to satisfy foreign clients. A surrogate birth in India can cost between $15,000 and $20,000, one-tenth of what some clinics in California charge.
Medical groups say the industry generates hundreds of millions of dollars a year in India, but there are few reliable statistics. In the two decades since the country’s first surrogate birth heralded a lucrative new frontier for medical technology, clinics have popped up so fast that authorities have lost track of how many are operating or how many babies have been delivered.
“In India we believe that motherhood is sacred, not something that can be traded to anyone with money,” said Jayashree Wad, a lawyer who has filed suit in India’s Supreme Court to abolish commercial surrogacy.
“The way this is being practiced in India amounts to sale of motherhood, in my view.”
Studies suggest Indian surrogates lack a detailed understanding of the contracts they sign with fertility clinics, which include sometimes risky medical procedures to ensure the paying couple gets a child.
The gestational surrogacy practiced in India involves transferring a fertilized embryo from a commissioning couple into the uterus of another woman. Doctors often implant multiple embryos to increase the chances of pregnancy and carry out most deliveries by caesarean section.
Both procedures are generally safe, but experts say surrogates are not fully aware of potential complications.
“Many of these women are from the poorest social classes and they come to this line of work due to poverty,” said Manasi Mishra of the Center for Social Research, a women’s rights advocacy group that has studied the practice extensively.
“Most have had only normal deliveries before, so they don’t have any knowledge about the procedures involved in a surrogate pregnancy. Some were only told halfway through.”
At the Origin International Fertility Center in Thane, a booming suburb north of India’s financial capital, Mumbai, doctors schedule C-sections for surrogates after they are 37 weeks pregnant, earlier than is typical in the United States. Clinicians said this reduces the risks that can arise if a woman goes into labor when medical staff isn’t immediately available.
“Every baby is a precious baby, but these are extra, extra, extra precious,” said Sandeep Mane, the British-certified doctor who directs the clinic. “It’s important you deliver the baby when all the help is available.”
Mane, who delivers about two dozen babies from surrogates each year, said the women’s health and nutrition are closely monitored. The clinic operates a temporary home where surrogates stay for the duration of their pregnancy, in a nondescript office building with a bank and Domino’s Pizza on the ground floor.
On a recent afternoon, Sunar and five other surrogates sat around a glass dining table as cooks served a lunch of vegetables, chapati and rice. The women sleep three or four to a room, with air-conditioning and satellite televisions that are almost always tuned to Indian soap operas.
To critics, the comfortable arrangements reinforce a sense that the surrogate pregnancy is more valuable than the women’s earlier pregnancies.
Sunar, smiling and wearing a lavender medical gown, said she was well looked after. She said she misses her children, ages 8 and 6, but her husband brings them to visit on Sundays when he has the day off.
His job as a security guard pays less than $100 a month, she said, which barely covers the cost of the children’s school. Her last surrogacy payment ran out after they made repairs on their one-room home in a tumbledown slum.
“He was supportive of me doing this again,” she said of her husband. “We both agreed to the contract.”
In the next room, Laxmi Bhalerao, 30, said she became a surrogate after her alcoholic husband left her alone to care for their two children. She was recruited by a neighbor who had been a surrogate herself, a common practice; clinics often pay referral fees of several hundred dollars.
“If I can buy a small apartment and take care of my children’s education, it will be worth it,” Bhalerao said.
There is desperation, too, among couples who saw India as their best hope of becoming parents.
After suffering a miscarriage in 2014, one Simi Valley couple decided to hire a surrogate from the Origin clinic and had just obtained medical visas for India when the ban was announced. In a letter, they described the “shock and disappointment” of learning that months of tests and planning had been wasted.
“We are extremely saddened by this decision and cannot comprehend why the Indian government has made such a dramatic decision, after helping infertile couples for so many years,” they wrote to Mane, who shared the letter on condition they not be named.
By banning foreigners — who account for the vast majority of the industry’s clients and usually are charged higher fees — the government is trying to end India’s reputation for what critics call “rent-a-womb” services. Mishra and other experts oppose the blanket ban, saying the government should instead set up a national registry of fertility clinics and enforce stricter rules.
Mane said the restrictions would harm Indian citizens who have benefited from the industry.
“There are a lot of ladies who need this for their financial security,” Mane said. “And who are we to decide how many births a lady can take? In the Middle East, they are having five babies and eight babies.”
But he was not worried about the future of his practice. More Indian couples are turning to surrogate pregnancy, he said, and the number of women willing to carry their children seems limitless.
“Many women would still come forward,” Mane said. “There are so many more out there.”