There is a growing
demand for Indian surrogate babies from foreigners but there is a lack
of a legal framework to deal with surrogacy, paving the way for
unscrupulous middlemen who push uneducated and poor women into
surrogate motherhood
After years of trying and treatment, US-based couple Jason and Nancy
are finally proud parents of a healthy baby girl. And their tiny bundle
of joy, Tara, was delivered for them by Ashaben through a surrogacy
arrangement at Kaival Hospital in Gujarat. An Israeli gay couple
experienced similar joy when, at Mumbai's Hiranandani Hospital last
September, they 'fathered' twins through a surrogacy programme.
Noted fertility expert Dr Indira Hinduja describes surrogacy as one of
the well-accepted methods of assisted reproduction that benefits
patients who can't conceive or carry a pregnancy to term. Of late,
there has been a growing demand for Indian surrogate babies from
foreigners, infertile couples in India and even single mothers — making
the country a preferred destination for such a service. As per the
Indian Council for Medical Research (ICMR) estimates, due to the upward
spiral in the number of surrogacy cases, the reproductive sector in
India is expected to rake in a whopping US $ six billion this year.
"After IT services," opines Dr Nisha Kathuria, a Delhi-based
gynaecologist/obstetrician, "it's now the turn of babies to be
outsourced from India. In these times of globalisation and
market-driven economies, there's considerable demand for this service."
Low medical costs
Indeed. And fuelling the demand is a slew of factors, including low
medical costs and a competent workforce. According to Dr Anoop Gupta,
Medical Director, Delhi IVF and Fertility Research Centre, the total
cost of renting a womb in India works out to around US$10,000 as
compared to about US$50,000 in the West. In the US, states the expert,
surrogate mothers are typically paid US$15,000, while the agencies
claim another US$30,000. In India, however, fertility clinics charge in
the realm of US$2,000 to US$3,000 for the procedure, whereas a
surrogate is paid anything between US$3,000 and US$6,000 — a fortune in
a country where the average annual per capita income is US$500.
But, despite the demand, surrogacy has its share of critics in India
due to the moral, legal and ethical debate that swirls around it.
Opines lawyer/activist Preeti Katyar, "If surrogacy becomes an avenue
by which women in richer countries choose poorer women in our country
to bear their babies, then it is economic exploitation, a kind of
biological colonisation."
A factor that has contributed to the negative feeling is the lack of a
definitive legal framework to deal with surrogacy and related issues.
While commercial surrogacy is banned in many countries — including
Italy, Australia, Spain and China — and permitted with restrictions in
the US, France and Germany, the Indian government is yet to formulate
any laws. In fact, the only guidelines, which regulate surrogacy — and
the clinics that provide ART (Assisted Reproductive Techniques) — are
the ones framed by the ICMR and the Ministry of Health and Family
Welfare in 2005. But these, point out experts, are nebulous and patient
and doctor-unfriendly. For instance, Section 3.10 of the ICMR
guideline states, "No relative or person known to the couple may act as
a surrogate." This, experts believe, is ludicrous as it propels
childless couples needlessly towards commercial surrogacy. In fact,
in-vitro fertilisation (IVF) experts say that in 90 per cent of the
surrogacy cases in India, the mother is related to the childless couple
while only in five per cent cases, the surrogacy is altruistic and in
the remaining five per cent, commercial. So, infertile couples are
forced to think twice before going in for it due to the costs involved,
which is unfortunate as India is home to 14 per cent of the world's
estimated 80 million infertile couples.
Legal ambiguity
Then there is ambiguity about a surrogate mother's rights. Delhi-based
lawyer Rita Row says, "The guidelines are skewed and thoughtless.
There's very little to protect the interests of the surrogate mothers."
The guidelines state that "a surrogate should be younger than 45 years"
without mentioning the minimum age. So does that mean an 18-year-old,
or someone even younger, can become a surrogate mother?
Also, what happens after the baby is born? "The biggest problem,"
explains Dr Gupta, "arises after the baby's birth. Foreigners are
unable to get legal assistance when it comes to taking the child back
home." According to the ICMR guidelines, a child born through surrogacy
"must be adopted by the genetic (biological) parents unless they can
establish through genetic (DNA) fingerprinting that the child is
theirs." Ergo, the only option left open to them is to ‘adopt’ the baby
— which is a very lengthy and cumbersome process in India.
Dangerous
The regulations don't provide legal protection to Indian parents,
either. The only legal recognition of the child's parentage is the
birth certificate, and it's only the birth mother's name that can be
used for this purpose. Consequently, if the birth mother decides not to
hand over the baby after birth, there's nothing the intending parents
or the doctor can do about it.
Unsurprisingly, with such ambiguous regulations in place, surrogacy in
India has become a dangerous playing field for unscrupulous middlemen
who entice and push uneducated and poor women into surrogate
motherhood. This practice also encourages the misuse of a surrogate
child for terrorism, prostitution or unethical genetic engineering
research.
India can take a few pointers from the US, which has strict regulations
in place — the law there mandates that surrogate agreements be
meticulously drawn out to delineate the responsibilities of intending
parents as well as the surrogate. "But in India," says Dr Kathuria,
"surrogacy has a high potential for abuse as the monetary stakes are
high." Admits Dr Raman Prakash, a Mumbai-based psychologist who also
counsels commissioning parents and surrogate mothers, "When anything is
influenced by economics, there's invariably a dark side to it."
No awareness
Experts believe that the basic problem is that people are not well
informed about surrogacy and its related issues. For example, a
surrogate's health is not given due priority. Fertility doctors are
allowed to implant up to six embryos in a donor's womb — in other
countries it's limited to three — which creates the risk of multiple
pregnancies and can lead to severe complications, stillbirth or even
the surrogate's death.
In many cases, the surrogacy option is used even when it is not
necessary. "Sometimes patients have had repeated IVF failures or
recurrent miscarriages," says Dr Kathuria. "Usually, a simple egg
donation is enough rather than a more complicated surrogacy option."
Doctors agree that a mass awareness campaign is key to making the
treatment more accessible to all. Many sensitive, surrogacy-related
issues too, need to be tackled. As Dr Asha Jaipuria, a social activist
and NGO worker puts it, "Who ensures that the woman's unused eggs or
embryos are not harvested/stored and then sold to couples who want
fair-skinned children? Or to couples who don't have viable eggs/sperms?"
Moreover, some questions need urgent answers, such as: what happens if
the surrogate dies during childbirth, is there due compensation for her
motherless children in that case; and what about the postpartum
psychological and emotional support for poor women surrogates?
There's also the issue of money. As the treatment is expensive, there
should be a regular audit to oversee the funds distribution to the
surrogates. It's time the government seriously considers enacting a law
to regulate surrogacy and related IVF/ART technologies in India to
protect and guide couples going in for such an option. Without a
foolproof legal framework, patients will invariably be misled and the
surrogates exploited.
http://www.deccanherald.com/Content/Feb162008/she2008021552510.asp
