Pitfalls of surrogacy in India
exposed By Neeta Lal
NEW DELHI - The tragic death last week of
30-year-old Premila Vaghela in the eighth month of
a surrogate pregnancy has highlighted deficiencies
in laws governing the US$500-million fertility
tourism industry in India.
mother of two, had agreed become a surrogate
mother for an American couple to supplement her
family income. She was undergoing a routine
check-up at Pulse Women's Hospital, an IVF (in
vitro fertilization) clinic in Ahmedabad, Gujarat
state when she had a convulsion and collapsed.
While she eventually died, a healthy baby boy was
delivered at the clinic by caesarean. Pulse
works in "international collaboration" with
Melbourne IVF, one of Australia's renowned
fertility clinics. The Pulse Women's Hospital
website describes it as "a modern hospital whose
mission is to provide
high quality international standard health care
that meets the needs and exceeds the expectation
of the people".
Dr Manish Banker from
Pulse told The Times of India last week that as
Vaghela was showing signs of distress, an
emergency caesarean section delivery was completed
before she was sent to another hospital. At that
hospital, staff said she had arrived in an
extremely critical condition. "She was suffering a
major cardiac arrest. We tried to resuscitate her
but she succumbed," said a senior official.
IVF experts say that under the terms of
most surrogacy contracts in India, the surrogate
mother and her partner agree that if the
childbearing woman is injured or diagnosed with a
life-threatening disease during advanced
pregnancy, she is to be "sustained with life
support equipment to protect the fetus viability
and insure a healthy birth on the genetic parents'
This legalese, say obstetricians,
translates as the clients' baby's health being put
first ahead of the surrogate's. "It is also not
uncommon in these transactions for the
semi-educated surrogate to be exploited by the
doctors and middlemen to benefit their rich
clients," says Dr Pratima Kaushik, a senior
gynecologist at Max Hospital, New Delhi.
"Vaghela's fate has highlighted that death is one
of the hazards of being a surrogate mother in
The baby boy's biological mother
has visited him at Pulse Women's Hospital and,
while apparently shaken by Vaghela's death, says
she plans to take him home soon. Meanwhile,
Vaghela's case has been described as an
"accidental death" by police pending a post
Activists say that had this mishap
occurred in a developed country like the US, the
hospital's license could have been revoked.
However, this was never certain in India, where
some IVF clinics have reportedly transfer up to
three embryos at a time (against the international
best practice of one) into a surrogate's womb to
ensure a pregnancy.
Despite the lack of
stringent, business in reproductive tourism is
thriving in India, growing at some 7% annually.
Physicians now oversee an estimated 2,000
surrogacy births a year for domestic and overseas
couples in India.
For thousands of
childless couples from the West - including the
US, the United Kingdom and Canada - faced with an
inability to conceive and the legal and fiscal
bottlenecks involving surrogacy in their native
countries, the low-cost surrogacy options in India
fill their hearts with hope.
the Center for Disease Control and prevention, the
total number of women between the ages of 15-44
years unable to bear children in the US was 7.3
million in 2010.
India, with its large
pool of agencies and nimble surrogacy laws as well
as its world-class medical infrastructure and
highly-trained doctors, has emerged as a hub for
wealthy wannabe parents. The money offered by
foreign couples attracts a steady stream of women
from the poor socio-economic strata to offer
themselves as surrogates.
Though banned in
many countries, surrogacy was legalized in India
in 2002. In 2008, the Supreme Court of India held
that commercial surrogacy is "permitted" in India.
In 2009, Gujarat High Court recognized the
nationality of the surrogate mother while
determining the child's citizenship. This legal
backing has provided an added impetus to
commercial surrogacy in the country with childless
international couples going to India with
Buttressing demand further are
IVF clinics that enthusiastically showcase the
testimony of happy surrogate mothers who have
become pregnant for foreign couples to prospective
Given the amenable business
environment, Gujarat, especially Anand with its
large number of IVF and surrogacy clinics, has
been pivotal in driving the business. India is now
known as the "surrogacy capital of the world".
Payments for surrogates can vary vastly -
they could receive anything between $5,000 and
$10,000 as per contract. Occasionally, when the
foreign couple is really happy, they may also tip
heavily ($1,000 to $5,000) after they receive the
child. Also, some couples like the surrogate to
eat well, so they also provide an additional food
allowance - from $100 to $150 per month until the
child is born.
Indian clinics, say
doctors, usually charge patients between $10,000
and $20,000 for the complete package, including
fertilization, the surrogate's fee and delivery of
the baby at a hospital. Even with the costs of
flight tickets, medical procedures and hotels
thrown in, this is a third of the price a
childless couple would have to cough up for an IVF
procedure, say in the United Kingdom. Given the
market dynamics, experts say this is the right
time for India to regulate the industry to protect
the rights of both surrogates and clients.
However, the Assisted Reproductive Technologies
(Regulation) Bill, 2010, is still awaiting
Besides the legislation are a
plethora of surrogacy-related ethical questions
that remain unanswered. Critics dub the practice
as "wombs for rent", "outsourcing pregnancies" and
"baby farms". Motherhood is not a "job" that can
be outsourced, they say, adding that Westerners
are "exploiting" poor women in India by hiring
them at a pittance to undergo the hardship, pain
and risks of labor.
However, those in
favor of commercial surrogacy say nobody is
forcing these women to become surrogates. They are
also remunerated for their efforts, which helps
this underprivileged lot to better the quality of
their lives. Besides, reproductive tourism is a
godsend for childless couples. So who is
exploiting whom and where is the coercion?
Vaghela's untimely death has highlighted
the lack of a regulatory mechanism for such
practices in a country notorious for its
staggeringly high maternal death rate. India
accounted for 19% of the estimated 287,000 women
who died in pregnancy and childbirth in 2010,
according to the United Nations. A 2011 survey by
a city-based non-governmental organization, Center
for Health Education, Training and Nutrition
Awareness, stated that a childbearing mother dies
every eight minutes in India.
than ever, India needs regulatory laws to protect
the rights of surrogates. In a country where there
are few reproductive rights and maternal deaths
are a chilling reminder of the sad plight of the
fair sex, unregulated commercial surrogacy is a
sure shot recipe for disaster.
Lal is a widely published writer/commentator
who contributes to many reputed national and
international print and Internet publications.
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