Womb service: How surrogacy still carries stigma in India

Amrit Dhillon     
Tuesday, 13 August, 2013, 10:37am

Western celebrities such as Elton John and Nicole Kidman have used surrogates to fulfil their desire for parenthood. Now with two of Bollywood’s biggest stars, Shah Rukh Khan and Aamir Khan, and their wives having taken the same route, surrogacy has gained some respectability, if not a hint of trendiness, in India.

While it still carries considerable stigma in the country, the celebrities’ choice has eased the way for other couples to do the same.

They made it seem like a perfectly acceptable way of bringing a baby home.
KABERI BANERJEE, FERTILITY DOCTOR

Even so, critics say the practice is prone to abuse because of the lack of regulation and the severe wealth gap there.

Aamir Khan surprised India when he and his wife, film director Kiran Rao, announced in 2011 that their baby son, Azad, was born to a surrogate. The actor already had children from his first marriage, but Rao opted for surrogacy as a “last resort” after suffering a miscarriage.

“The publicity around their case helped to clear up a lot of misconceptions. They made it seem like a perfectly acceptable way of bringing a baby home. That’s the power of celebrity,” says Dr Kaberi Banerjee, a fertility specialist in New Delhi.

Then, in May this year, Shah Rukh Khan and his wife, Gauri, announced that after trying to have a child for two years, their baby son, AbRam, had been born in Mumbai to a surrogate. The couple have two other children.

Surrogacy is a US$2.3 billion business in India. Its established medical infrastructure, coupled with a surfeit of poor women desperate to earn some money by renting their wombs, have turned the country into a preferred destination for childless couples from around the world looking for a low-cost, straightforward way of becoming parents.

But because the procedure is unregulated, it’s open to malpractice. A study by the Centre for Social Research in New Delhi last year found that most of the 100 surrogate mothers interviewed did not understand the procedure or the contract they signed with commissioning parents and fertility doctors.

While awaiting the births, they are often forced to live in guarded homes and given only limited access to their families.

“We found that 60 per cent were illiterate. That means they are easy to exploit because they won’t understand the possible medical complications,” says the centre’s director, Dr Ranjana Kumari.

Other controversies surround the process, including issues of gender selection and caste.

A survey last year by the Delhi women’s group Sama showed Indian couples were prepared to pay more for a light-skinned surrogate from the right caste.

The survey said couples often used the same adjectives to describe the kind of surrogates they wanted as those used in matrimonial ads – fair, beautiful, high caste.

“Indians are obsessed with religion, caste and fair skin. Even when they are told that the baby won’t have any of the surrogate’s characteristics, they still feel that some mingling of blood and tissue in the womb will affect the outcome,” says Deepa Venkatachalam, Sama’s programme co-ordinator.

But Dr Naina Patel, who runs a fertility clinic in Ahmedabad, says most commissioning parents simply want the surrogate to be healthy.

“They sometimes ask about the caste, but their main concern is that she be healthy and follow a healthy diet while carrying the baby,” Patel says.

But in what is manifestly an unequal relationship, it is the commissioning parents who call the shots and set the conditions. Surrogate mothers are usually too poor and powerless even to demand the right to be with their families during the pregnancy.

Women’s groups point out that this inequality extends to the spousal relationship. When the fee is paid, it is usually the husband who decides how to spend it.

“In some cases, he uses it to pay off a loan, just fritters it away or starts some ill-conceived business which fails. The woman often has no say,” says Brinda Karat, a Communist Party politician and women’s activist.

That is why many surrogates, such as Sangita Rana, offer their wombs a second or third time.

“My husband started a business selling packed meals to office workers. It failed, and he lost the money I made from having a baby. So I’m here to do it again,” Rana says while awaiting a check-up at the Delhi Research Centre.

Fearing being ostracised, they carefully hide this arrangement. “My husband tells our relatives that we are moving for a year because of his job. They would refuse to speak to us if they knew what I do,” Rana says.

So, while becoming a parent by surrogacy is losing its stigma for celebrities, earning money this way is still a disgrace.

 

This article appeared in the South China Morning Post print edition as Womb service

Of surrogacy and the law

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AARTI DHAR

August 1, 2013 10:19 IST  

Against concerns of lack of clarity and sufficient protection for surrogate mothers in the draft ART Bill, 2010, the Planning Commission is set to appoint a committee for wider consultations

The Centre will set up an expert committee for wider consultations on the draft Assisted Reproductive Technologies (ART) Bill, 2010. The committee will deliberate upon very “grave and critical” concerns raised by stakeholders and explore possible ways to address these issues. 

The decision was taken after the Planning Commission recommended substantive changes in the legislation and advised the Indian Council for Medical Research (ICMR) against pushing the draft Bill till the process of consultations was satisfactorily concluded. 

The Planning Commission will coordinate the process of forming and facilitating this committee towards developing an efficient regulatory framework and legislation. This comes after a meeting convened by the plan panel with stakeholders in the Capital earlier this week who made a pitched demand for setting up an expert committee to look into some of the provisions of the Bill, according to Sama, a non-governmental organisation working on women’s health. 

Sama has been engaged in Assisted Reproductive Technologies and commercial surrogacy, through research, advocacy, and creation of resources (including a recent film on surrogacy) over the past eight years. 

The outfit was invited by the Planning Commission as part of their Civil Society Window initiative to present its views on commercial surrogacy in India.  The meet, chaired by Dr. Syeda Hameed, Member, Planning Commission, was attended by representatives from the Planning Commission, Union Ministry of Health and Family Welfare, ICMR, Union Ministry of Law and Justice, the National Commission for Protection of Child Rights (NCPCR), and Office of the Registrar General of India, amongst others. 

The discussion flagged concerns with regard to the unregulated industry, unethical practices, especially lack of protection of the surrogate women’s health and rights, sex selection, lack of employment opportunities, and other health and rights issues of children born through surrogacy arrangements, and issues related to their citizenship. 

Given the presence of Dr R.S. Sharma (member secretary Drafting Committee of the Draft ART Bills 2008 and 2010), the deliberations focused on the content and provisions of the Bill. The “short-sightedness” of some of the provisions, the absence of sufficient protection for surrogate women and in general the lack of transparency, consultative processes involving domain experts, including organisations in the drafting of the Bill,  and lack of clarity on nodal authority, were issues raised by the members. 

The ART Bill has been hanging fire since 2008 when the first draft was prepared. It was revised in 2010 but is yet to get a final approval from the Union Law Ministry following which it will go to the Cabinet for clearance.

Commercial surrogacy is a multi-million dollar industry in India but there is no legislation to regulate surrogacy which is resulting in exploitation of poor women who offer their wombs for a price without realising the adverse health impacts.   

Health activists feel that the ART draft Bill is designed to regularise and promote the interest of the providers (mainly the private sector) of these technologies rather than regulate and monitor the current practices. The Bill is also inadequate in protecting and safeguarding the rights and health of the women who undergo these ART procedures, surrogates, egg donors and of the children born through these techniques. 

In the context of surrogacy, the draft Bill at present constructs surrogacy as an isolated problem and proceeds to resolve conflicts engendered by the practice, a perspective that is in favour of the industry. The surrogacy industry, in effect, seeks to open up the market by removing any legal impediments in its smooth functioning. It is also decidedly in favour of commissioning parents, Sama points out. 

“Lack of transparency from ICMR on this ART Bill is quite known to us for many years. We were appalled to learn that ICMR has again revised the draft Bill 2010 which we came to know only at the Planning Commission (the 2012 ART Bill is not on the ICMR website). The Ministry and ICMR have never made an effort to have any consultation on this Bill with women’s rights, child rights, health rights and legal rights organisations,” activists said while hoping that the Planning Commission meeting would lead to some positive outcome towards greater civil society participation.

No surrogacy for foreigners: tough new rules planned

The Indian Express

Abantika Ghosh : New Delhi, Thu Aug 08 2013, 09:09 hrs

The directorate general of health services (DGHS) has proposed that the option of surrogacy should be available only to married, infertile couples of Indian origin.

The suggestions forwarded by DGHS Dr Jagdish Prasad to the department of health research rule out surrogacy options for foreigners, unless they are married to a person of Indian origin. The suggestions also say that a woman may become a surrogate mother only once in her lifetime.

The health ministry, which is engaged in a tussle with the Planning Commission on NGO consultations over a law to regulate the “infertility” industry, has circulated a cabinet note on the Assisted Reproductive Technologies (ART) Bill. The DGHS is an arm of the ministry.

According to a recent survey on surrogacy done by a Delhi-based NGO, foreigners made up 40 per cent of the clientele, and were inevitably those who paid the most. It is estimated that approximately 2,000 babies are born every year in India through commercial surrogacy. According to CII figures, surrogacy is a $ 2.3 billion industry in the country.

According to the NGO’s survey, surrogate women were forced to live in hostels away from their families for a few lakhs, a sum that they forfeited in case of complications or a miscarriage.

There were allegedly cases where more than one woman were made pregnant with a couple’s children to increase the chances of success. After a certain cut-off period, all but one were forced into a miscarriage without telling them.

The DGHS suggestions, coming on top of the health ministry’s disagreements with the Plan panel on whether and to what extent NGOs should be consulted, have further dimmed the chances of a Bill that has been in the works for over five years, making it to the cabinet anytime soon.

Planning Commission member Syeda Hameed said, “Organisations like SAMA have worked extensively in the field and have domain expertise.

 

We have decided to make a small core group of the commission to see how we can use that field knowledge to make valuable additions to the Bill.”

Sources said the ministry has been less than forthcoming in accepting the panel’s insistence on wider stakeholder consultations.

DGHS Prasad has also suggested that the potential surrogate mother would have to be aged between 25 and 35 years, and may not have more than two children of her own. The original note made surrogacy services available to individuals, which by extrapolation meant gay/lesbian couples could opt for it, but Prasad has suggested a far more narrow band of eligibility in which only married couples qualify.

ICMR deputy director general Dr R S Sharma, who is dealing with the ART Bill, said he had not received Prasad’s suggestions. “He has spoken to me on the issue but his written suggestions will come to me through the department of health research,” Sharma said.

Prasad declined to elaborate on his suggestions but said they were important to regulate the industry. “There is a lot of corruption right now, from the way women are exploited to how the babies are treated by the foreigners who take them. There is a need to make a foolproof law,” he said.