I am reading Rampuri’s ‘Autobiography of a Sadhu’ at the moment and there is a wonderful part where another sadhu complains, ‘When you white people first came, you were rich, important and powerful. You were sahibs and governors and viceroys even….’ Rampuri explains that ‘they’ came to conquer and rule, but ‘we people’ have to come to learn from you. So, says the sadhu, ‘…before you came to take our land and our wealth, and now you come to take our knowledge!.....what will you give for the knowledge? Or you just take it and run away?’. But then he laughs and exclaims, ‘Take it, take it all…….we give it all to you with love!’
[1]
India has certainly been the source of many riches for the West: first it was tea, cotton and spices, then human skeletons for medical students
[2], then seekers of knowledge and enlightenment and now ……wombs. Or at least wombs for rent by couples desperate for children from the UK, the US and elsewhere. The practice is also growing among well-off Indians as well, as it was revealed earlier this year that Shah Rukh Khan, the Bollywood star, and his wife had their newborn son carried by a surrogate.
Surrogacy in India is a booming industry, one worth an estimated $2.3 billion a year in revenue. 25,000 babies are estimated to have been born since commercial surrogacy was legalised in 2002, with 50% of those from the West. Around 30% of commissioning parents are thought to be either single or homosexual (presumably from outside India). In the UK, while surrogacy is legal, commercial surrogacy is not, whereby a surrogate mother is contracted to carry a baby for a fee. In practice in the UK, however, the surrogate mother typically is given a sum of around £10,000 – 15,000 as some kind of compensation, which, although not meant to be a fee is usually authorised by the courts once the baby has been born. Importantly, however, contracts in the UK are not enforceable (so a surrogate might change her mind) and the legal mother is always the woman giving birth, not the genetic mother – necessitating legal involvement to transfer legal parenthood via parental order or adoption.
In India, by contrast, contracts are enforceable – meaning a surrogate mother cannot change her mind and decide to keep the baby. Legal parenthood is with the genetic mother and father – not the surrogate who carries the baby. Crucially, because the costs of living and medical care are cheaper in India, costs of surrogacy are much lower.
BBC 4’s excellent documentary, ‘The House of Surrogates’ last week focused on the Akanksha Infertility clinic in Anand, Gujarat, run by fertility specialist Dr Nayna Patel. Dr Patel first came to prominence in 2004 when she helped a woman in India become a surrogate mother to her own grandchildren. She realised the potential of surrogacy and established her clinic where around 100 surrogate mothers at any one time stay in an attached dormitory. Couples pay the clinic around $28,000 (around £17,500), of which the surrogate mother gets $8,000 (around £5,000) – a fraction of what this might cost in the USA, where commercial surrogacy is also legal. For this, the clinic can create in vitro embryos from the genetic parents’ egg and sperm which are then implanted into the surrogate mother (1 or 2 – the rest frozen. This is for full (IVF) surrogacy – partial surrogacy would fertilise the surrogate mother’s own egg with donor sperm). The surrogate will stay in the dormitory – forbidden from staying with her family - for the duration of her pregnancy, where she is fed, monitored and encouraged to rest before giving birth and the baby collected by the genetic parents. This is to ensure the surrogate mother receives adequate nutrition and vitamins and avoids hard physical labour which might jeopardise the pregnancy.
The set up is obviously controversial, with Dr Patel having come in for much criticism over time. But, she describes herself as a strong feminist and says it is all about women helping each other. Dr Patel says people have two basic instincts: to survive and to procreate. As she sees it, she is helping with both: the surrogates survive with the money they are paid, and the childless couples procreate. It is hard not to have some sympathy with this viewpoint – at a purely rational level, it’s a win-win situation. The couples get a much-wanted baby they otherwise would not have been able to have, while the surrogate mother is paid a life changing sum of money than she might never earn – enough to build a house or pay for children’s education.
To watch the actual practice of this though, on a large scale – a production line, or ‘baby farm’ is quite another thing. To be a surrogate on an informal basis, for perhaps another family member is one thing - but this is very different from commercial surrogacy as a business. As clinics go, Dr Patel’s seems well-run and, while the women sleep 8 or 10 to a room in fairly basic accommodation, this has to be contrasted with conditions they might have come from in villages. Dr Patel herself is very much the matriarch running the show. Her concerns seem patronising at times – for example, in vetting how the women plan to invest or spend the money. But she also provides some education for new skills whilst the women are pregnant – both to relieve boredom and so they might be able to earn their own money afterwards. I might have preferred IT, health care or business skills rather than the sewing, embroidery and beauty on offer – but this might reflect a pragmatism about the most realistic way for these women to gain income from self-employment, and their lack of basic education, rather than returning to financial dependency or hard, low paid manual labour.
The technology in the clinic seemed as good as any clinic in the West – though I was a bit concerned (from an ethical standpoint) at how easily Dr Patel was persuaded by the couple to implant 2 embryos, not 1 – seemingly without discussion with the surrogate mother of any potential increased risks to her.
What was harder to watch was the behaviour of some of the Western couples. They clearly must have been desperate to have gone to these lengths for a baby, but to see a Canadian woman inspect the potential surrogate mother for her next child – ‘good hips, not too small and the preferred religion of Christianity’ – seemed little better than inspecting cattle at a market. Then an American woman who came to meet and collect her baby, barely glancing at the woman lying on the bed who had just given birth. Such conduct might reinforce Indian sensibilities about rich Westerners although it is debatable whether rich Indians would have behaved any better.
But to think of the surrogate mothers as just being exploited doesn’t do justice to the complexity of the situation. The women seem to know exactly what they are getting into, and do so with the backing of their husbands and families. Yes, it is commodification of their bodies, perhaps reducing them to a purely biological role of baby carrier. But so is exploiting an intelligent person’s learning in a company or the muscular strength of a man on a building site. These women are probably making a calculated decision, faced with a limited number of options for earning money. Yes, poverty is the driving factor – but then it is a driving factor in the vast majority of people’s willingness to engage in any kind of paid labour. And Dr Patel hasn’t done too badly either – as she invests in building a new ‘one-stop shop’ costing around $6 million.
The legal situation, however, is not as straightforward as clinics might lead couples to believe. If the parents are domiciled in the UK, UK law will apply to them no matter where the conception takes place. This can mean, therefore, that for a baby born to a surrogate mother in India, whose genetic parents are UK domiciled, neither parent will be the legal parent. In India, because the legal parents are the genetic parents, but in the UK the legal mother remains the surrogate mother who gave birth. The child would therefore be born an orphan.[3]
Calls for more regulation in India have led to a proposed Assisted Reproductive Technology (Regulation) Bill, currently under discussion. Proposals include banning homosexual couples, single individuals and unmarried couples from surrogacy in India, enabling direct negotiation between the surrogate and commissioning parents for the fee, an age limit on surrogates and a limit on how many pregnancies (including her own) she can carry. Whether this will be enough for effective legal and ethical regulation remains to be seen. The ban on same sex couples is clearly discriminatory (same sex couples are not legal in India), although the argument is that it aims to protect the rights of the offspring where same sex adoptive parents might not be legal or recognized. If this ban goes through, however, it will clearly be bad for the surrogacy business in India.
Perhaps the voices not heard in the surrogacy debate are those of the babies born, and the longer term psychological effects on them knowing they were ‘manufactured’ in an Indian womb. For the moment though, surrogacy in India continues – perhaps not given purely with love (as with knowledge) but for the right fee.
A postscript: While US mothers are turning to Indian surrogates, wealthy Chinese couples are seeking US surrogate mothers. This can evade the strict one-child policy in China, whilst also under US law the child is a US citizen if born there – and can apply for a green card for their parents once they turn 21. Chinese agencies are offering a basic surrogacy package for $120,000 to $200,000 – meaning that, as one agent put it – for around $300,00 (including plane tickets and other expenses) you can get 2 children and the whole family can emigrate to the US. A future vision of a global roundabout in the production of children comes to mind, with international outsourcing of the manufacture of babies across the globe. A nightmare scenario, or one that is just using new technologies to everyone's advantage that in time will become as accepted as modern medicine, the internet or cars?
[2] Very lucrative, until the Indian government banned the export of skeletons in 1985 – which probably just drove it underground instead
[3] See the cases of
Re G (Surrogacy: Foreign Domicile [2007] EWHC 2814 (Fam) and
Re X&Y (Foreign Surrogacy) [2008] EWHC 3030 (Fam)
Diwali arrived in London last Sunday – a week too early according to Susen’s cousin in Kolkata where the celebrations take place on 3 November. But, as Susen said, we can be flexible. There are many paths and many ways to celebrate.
ri with jeans and Doc Marten’s though, but you 
n
ever know.
