~ 197 ~

SURROGACY IN INDIA: A WALK FROM CONSERVATIVE TO PROGRESSIVE OUTLOOK

~ 198 ~

“Neither flesh of my flesh, nor bone of my bone, but still, miraculously my own.”

es, this is the magic of Outsourcing Motherhood but can we call it magic in true

sense. It is a debate of our head and heart. ‘Outsourcing’ and that too

‘Motherhood’! Doesn’t it impinge you? Former one is a buzz in business and the later, in

our hearts. And to give it a respectable name we combine both the buzzes and call it

“Surrogacy”.

The practice of renting a womb and getting a child is similar to Outsourcing Pregnancy.

Despite the legal, moral and social complexities that shroud Surrogacy, there is nothing

stopping people from exploring the possibility of becoming a parent. Women who may

choose to ‘Rent’ their womb for a Surrogate Pregnancy are slowly shaking off their

inhibition and fear of social ostracism to bring joy to childless couples. Under this chapter

the researcher has discussed the Social Scenario of Surrogacy in India especially in

Gujarat, Maharashtra, Rajasthan and Madhya Pradesh, from its inception till the present

time. The chapter further unveils the reasons for the growth of the Multi –Million

Surrogacy industry in India.

INDIAN SCENARIO

Over the past few years, India has seen an explosion of fertility services that promise a

cure for the allegedly increasing rates of infertility. Assisted Reproductive Technologies

(ARTs),1 a group of technologies that assist in conception or in the carrying of pregnancy

to term, have proliferated unchecked, becoming a veritable ‘Fertility industry’.

___________________________________________

1 Assisted Reproductive Technologies (ARTs) are a group of technologies that assist conception and pregnancy. These technologies are designed to increase the number of eggs and/or sperm, or to fertilize them, resulting in the improved ‘probability’ of conception/pregnancy that is not otherwise possible. The technologies used for assisting reproduction range from simple or ‘low-tech’ methods such as intrauterine insemination (IUI) to ‘high-tech’ methods such as in vitro fertilization (IVF) in all its variations. Although surrogacy is an arrangement, it has been included in ARTs.

Y

~ 199 ~

This industry is an integral part of the country’s expanding medical market and medical

tourism industry. Within this, surrogacy, particularly Commercial Surrogacy, the practice

of gestating a child for another couple or for an individual through the use of ARTs and in

return for remuneration, has drawn much attention and raised several ethical concerns. In

the absence of any kind of Regulatory or Monitoring mechanism for the ART industry in

India including a national registry, it is difficult to arrive at the exact statistics pertaining to

the existing Surrogacy industry. However, the sharp rise in the number of Surrogacy

arrangements based on media reports and anecdotal evidence is a significant indicator for

estimating the scale and spread of the Commercial Surrogacy market. An exponential

growth in the industry is evident from the comparative figures over the years that was

estimated it to be an industry worth more than USD 400 million till 2008.2

But, still it’s not clear how big the Indian Surrogacy market officially is, how many

Surrogate Children are birthed each year or how many ART clinics there are. Birthing a

Market, A Study on Commercial Surrogacy (2012) by Delhi-based Sama - a resource

group for women and health – was supported by the United Nations Population

Fund India; it quotes figures from the National Commission for Women to peg the

number of clinics in India offering Surrogacy services at about 3000. There has, however,

been no confirmation from the Government on these figures.

At present, the volume of this trade is estimated to be around $ 5000 million and the

numbers of cases of Surrogacy are increasing rapidly.3 On the other hand, the

Confederation of Indian Industry (CII) figures identify Surrogacy as a 2.3 billion dollar

industry annually. The CII study estimated that 10,000 foreign couples visit India for

reproductive services. It’s not just foreign couples alone but the demand for Surrogates

from Indian couples is also growing.

____________________________________________ 2 Warner, J.,Outsourced Wombs, New York Times, 3 Jan., (2008). and Kohli. N., Moms Market, Hindustan Times, 3 Jan., (2011)

3 http://www.mightylaws.in\outsourcing-motherhood may 2012.htm

~ 200 ~

Estimates by Doctors indicate that up to 40 per cent of their clients are foreign

couples/Indians living abroad, implying that a significant proportion of clients are resident

Indians. As the researcher pointed before that the exact extent of this practice in India is

not known, but inquiries have revealed that this practice has doubled in the last few years.

There is a growing demand for fair-skinned, educated young women to become Surrogate

Mothers for foreign couples. Often, couples have to wait for as long as eight months to a

year for their turn. Normally women from small towns are selected for outsourcing

pregnancy.4 In places like Anand, Surat, Jamnagar, Bhopal, Indore, a large number of

couples from both within India and abroad travel to fulfill their desire for a child. Several

American, Russian and British women are duly registered with the Akankshya Clinic of

Anand and the Bhopal Test Tube Baby Centre for the procedure.

Leading fertility expert Dr Firuza R Parikh, Director - Department of Assisted

Reproduction and Genetics at the Jaslok Hospital and Research Centre in Mumbai, points

out that Indian IVF Clinics have good results, which create huge potential for expansion

“India can

become a very

big Hub for

Surrogacy if

the ART bill

gets tabled in

Parliament and

if international

and Indian

clients have

clarity on the

issue.’’ She

adds that

transparency of all processes and having a law rather than a bill, would help all concerned.

__________________________________________________

4 Surrogate mothers: Outsourcing pregnancy in India‘ article by Joseph Gothia, 26th June 2008, link: http://india.merinews.com/cat Full.jsp?articleID= 136421

~ 201 ~

As we emerge as a hub for surrogacy, there may be further refinements in the ART bill, but

delays are not helping, ’’ adds Parikh.5 She estimates that around 2500 to 4000 Surrogacy

cycles per year are performed in India. One successful cycle of Surrogacy in India can cost

anywhere between Rs 11-20 lakh (between 25-35,000 USD). In smaller cities, it can be

cheaper.

According to the National Commission for Women (NCW), there were about 3,0006

clinics in early of last decade which has now crossed over two lakh across India offering

Fertility treatment and out of them many are providing Surrogacy services to couples from

North America, Australia, Europe, and the other continents. These figures reflect the status

of India as the most favored destination for Commercial Surrogacy. This comes as a boon

to childless couples all round the world. At the same time it raises serious ethical and legal

concerns and mirrors the plight of the poor in an underdeveloped country, who are willing

to sell something as sacrosanct as their Women’s Motherhood.

Conservative to Progressive Approach

“In India, it is estimated that approximately 15 to 20 per cent couples suffer from

infertility, “says Dr Anoop Kumar Gupta, Medical Director and Infertility Specialist

of the Delhi In-Vitro Fertilization (IVF) Center.” The figure is on the increase due to

increased urbanization, pollution, stress, a competitive work environment and a fast-paced

lifestyle,” he adds. Various surveys reveal that the figure of childless couples is increasing

at an alarming rate unanimously in all the countries. For the treatment of fertility various

Artificial Reproduction Techniques are developed and Surrogacy is the latest out of them.

Surrogacy is a complex and challenging topic that is plagued with controversies for the

past several decades. There are many legal, social and ethical aspects of a pregnancy

involving a Surrogate Mother.

___________________________________________

5 http://indiatogether.org/what-surrogate-parenting-entails-in-india-laws

6 Kannan, S., Regulators Eye India’s Surrogacy Sector, 2009, BBC World News, 18 March.

~ 202 ~

There have been some famous cases which garnered public attention and have given rise to

endless debates in favor of as well as against the procedure. India created history by being

the first country to legalize Commercial Surrogacy in 2002. Internationally, India has

become the preferred destination for couples desiring pregnancy through Surrogacy

although it is difficult to estimate the prevalence of Surrogacy in India. Today Surrogacy is

a booming business in India which leaves behind the traditional values and ethics.

Surrogacy is prevalent from ancient era but with the march of time the conservative

outlook towards Surrogacy has changed into a progressive outlook.

Mythological Surrogate Mothers are well known in India. Yashoda played mother to

Krishna, although Devki and Vasudeva were Biological Parents. Likewise, in Indian

mythology Gandhari made Dhritarashtra the proud father of 100 children, although he had

no biological relationship to them.7 No doubt, Surrogacy was prevalent in earlier time even

but it was not having a social acceptance.

With the lapse of time and progress of society the old concept of Surrogacy has totally

capsized. The primordial urge to have a biological child of one’s own flesh, blood DNA,

aided with technology and the purchasing power of money, and coupled with the Indian

entrepreneurial spirit, has generated the ‘Reproductive Tourism Industry’, estimated at

Indian rupees 25,000 crores (US$5000 million) today.

In 1984 the world saw the first successful birth through Gestational Surrogacy. Ten years

later, in Chennai, this happened for the first time in India. Three years after that, in 1997,

an Indian acted as a gestational carrier, and got paid for it, in order to obtain ‘medical

treatment for her paralyzed husband. But India’s Surrogacy boom began in January 2004

with a grandmother delivering her daughter’s twins. The success flashed over the world,

literally spawning a virtual industry in the State of Gujarat in India.

__________________________________________________ 7 Anil Malhotra & Ranjit Malhotra, All aboard for the fertility express, Commonwealth Law Bulletin, 38:1, 31-41, (2012) DOI: 10.1080/03050718.2012.646733 http://dx.doi.org/10.1080/03050718.2012.646733

~ 203 ~

In the past couple of years, the number of births through Surrogacy doubled with estimates

ranging from 200 up to 350 in 2008 alone. Today, while Iceland has the first openly Gay

woman politician as its Prime Minister, India boasts of being the first country intending to

legalize Commercial Surrogacy, in 2002, to legitimize both Intra and Inter-country

Surrogacy, which is rampant.

The term Surrogacy which was till last decade heard once in a blue

moon is now no more an unheard term in India. It has not only marked

its inception in metros but has with very swift pace moved towards the

small cities like Badwani, Indore etc. The outlook of masses towards

Surrogacy has undergone a vital change in last decade. This progressive

change towards Surrogacy can be witnessed from the mushroom growth

of fertility clinics dealing in Surrogacy in small cities as well as from the

numerous advertisements published in Newspapers for hiring a

Surrogate by the intended parents from time to time.

In the Indian context, the following factors have created a conducive environment for the

expansion of the industry: lack of regulation; comparatively lower costs in relation to many

developed countries for instance, Canada, the United Kingdom (UK), and the United States

of America (USA);

shorter waiting time;

the possibility of

close monitoring of

Surrogates by CI

(Commissioning

Parents); availability

of a large pool of

women willing to be

Surrogates, and

infrastructure and medical expertise comparable to international standards.

~ 204 ~

The motivations of women’s in India to enter into Commercial Surrogacy arrangements

stem from the emergent conditions of survival or deprivation. Their choices and

engagement in this and other options of work are also steeped in their perception of their

roles and responsibilities towards their children and families. Contrary to the more popular

discourse of altruism of giving the gift of motherhood to an infertile woman, the idea of a

good and responsible mother for their children and responsibility towards their families is

what seems to be gearing women into not just considering but also, often, convincing their

husbands into agreeing for them to enter such arrangements.

Some Surrogates have also chosen Surrogacy over other available work options, for

instance, domestic work or other kinds of work that are too arduous and have long working

hours, or have stated a preference for remaining at home and earning money. Their choices

are thus a reflection also of the constraints of the larger context of work availability or

unavailability and of the factors that influence the employability of women from a

particular class and that hence structure their lives.

These processes of constituting new subjectivities are seen to take place in the context of

the growing popularity of Surrogacy as an option for working-class women, and of the

scale achieved by the industry in a short span of time. The nature of labour in developing

countries like India in an international regime of globalization and liberalization has made

the flourishing of this industry possible.

As briefly addressed before, India is rapidly becoming the most popular country for

‘Fertility Tourists’, which is due to a number of interrelated factors which includes;

relatively low-cost medical services, the easy availability of Surrogate wombs, an abundant

choice of donors with similar racial attributes, and the lack of any law to regulate these

practices is attracting both Foreigners and Non-Resident Indians (NRIs) to sperm banks

and Surrogate mothers in India.

~ 205 ~

Now let’s us discuss these reasons for the growth of the proliferating Multi-million

Surrogacy industry in India in lucid and elaborated manner.

Low Cost Surrogacy Easy Availability of Pool of Willing Surrogates Abundant Choice of Donors Lack of Regulatory Laws Expertise Medical Services Supportive Machinery

Low Cost Surrogacy

Surrogacy in India is a hot topic right now. Intended parents are interested in the low costs

of International Surrogacy, and many are considering Surrogate Pregnancy in India. There

are many many success stories on Surrogate babies born in India.

Hundreds of happy parents have brought their children home without the least bit of

difficulty, while being able to afford Surrogacy, something they may not have been able to

do in their own Country. For those seeking a Gestational Surrogate Pregnancy, who will be

using their own eggs, the number one incentive to Surrogacy in India is the price.

It would be silly to imply that there was any other major reason for choosing to go through

International Surrogacy or Surrogate Parenthood in India. The reason that Intended

Parents go to India is 100% because of the cost, quoted at $20,000-30,000 of the entire

Surrogacy process. On the contrary, it is estimated that in the United States, the payment

for hiring a Surrogate Mother ranges between US$15,000 and $30,000, the whole

procedure can cost $45,000 to $60,000 plus.8

______________________________________________________________

8 http://www.delhi-ivf.com/india_surrogacy.html

~ 206 ~

The fees for the rest of the process including fertility clinics; lawyers; medical fees; and

agencies and/or egg donors, if they're used, generally cost more than the fee going to the

Surrogate. Gestational Surrogacy costs more than Traditional Surrogacy, since more

complicated medical procedures are required. Surrogates who carry a baby for a family

member i.e., sister or daughter usually do so for expenses only.

Here it is docile to mention the argument of Qadeer who argues that there is no way to put

a value on a human baby but arbitrarily, and asserts that therefore this value has to be the

same everywhere in the world, including in the third world where poor women who

become Surrogates provide cheap labor. She compares the situation in India with the

situation in the United States, where hiring a Surrogate is many times more expensive and

where she is better provided for in terms of medical expenses, health insurance including

for her family, expenses for maternity care and clothing, and the hiring of an independent

lawyer.

She compares Surrogacy with Human-Organ Donation to demonstrate that, unlike the

former, the latter has been restricted to a non-commercial transaction by the state.

According to her, this “distinction between human body parts donated and those rented,

and the equating of goods and living beings in Commercial Surrogacy” is irrational.9 This

logic obscures the difference between the product of social human labor, such as any

consumable commodity, and the product of women’s procreative labor, a baby.

Hence, India is foremost in Surrogacy because of the low cost treatment and availability of

women opting to be Surrogate for childless couples. According to the 228th report of the

Law Commission of India, “NEED FOR LEGISLATION TO REGULATE ASSISTED

REPRODUCTIVE TECHNOLOGY CLINICS AS WELL AS RIGHTS AND

OBLIGATIONS OF PARTIES TO A SURROGACY” the usual fee for Surrogacy in

India is $25,000 to $30,000 which is almost one third to what it would cost in USA. 10

___________________________________________________________

9 Supra note 38, Chapter III, at 102

10 http://lawcommissionofindia.nic.in/reports/report228.pdf

~ 207 ~

Moreover laws in US and UK do not allow the Surrogate woman to charge the childless

couple; whereas in India there are no laws preventing a Surrogate woman in accepting

compensation for renting her womb. A Childless couple offer Rs.3,00,000 to Rs.4,00, 000

or more and sometimes even funds for education to the children of Surrogate woman and

still save thousands of dollar as compared to their own country. Thus, the entire process of

Surrogacy in India is very cost effective and this is the prime factor behind the flourishing

Indian Surrogacy industry.

Easy availability of pool of willing Surrogates

There are several reasons why a couple from the developed world might want to travel to

India for Surrogacy. UK law dictates that Surrogacy must be altruistic, which has led to a

severe shortage of women willing to be Surrogates. The amount of money legally payable

to Surrogates to cover expenses tops out at around £10 000—nowhere near enough of a

financial incentive. Not only that, Surrogacy agreements is not enforceable in the UK. This

means that after months of searching for the right Surrogate and waiting for the baby to be

born, the prospective parents might be left bereft of their baby. This can happen in the

USA too.

In India, meanwhile, these problems are almost non-existent. For one thing, the Surrogacy

agreement is legally binding. Cultural and Financial factors also mean that Surrogate

Mothers rarely want to keep the baby. The taboo around Surrogacy means that most

women keep their pregnancy largely a secret. Indian Surrogates are often struggling to

provide for the family they already have; they can't afford not to get paid. Fertility Doctor

Kaushal Kadam, at the Corion Fertility Clinic in Mumbai, says that if anything,

Surrogates ask her “you are sure they are going to take the baby, right? I can't afford to

raise three children”.11

_________________________________________________________

11 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961933-3/fulltext

~ 208 ~

Indian Surrogates earn between $5000 and $7000—an enormous sum for women would

normally only earn about $300 a year. The women's financial desperation has led some

ethicists and women's rights groups to feel that Surrogates are being exploited. Yet it is

precisely because the women have so few alternatives to earn money that some doctors feel

they cannot take a moral high ground. “I really don't see any exploitation”, says Kadam.

“It's a mutually beneficial situation where the couple is getting their baby and the

Surrogate is getting benefited in the end.”

In this scenario, Commercial Surrogacy is often portrayed as a win-win situation. It is seen

to give ‘Desperate and Infertile’ parents the child they want, and to provide poor Surrogate

women the money they need. In the face of this growing globalization of capital and

shrinking local avenues for jobs and resources, women from marginalized communities

and regions find themselves more impoverished, powerless and vulnerable. For these

women, access to work and occupations has decreased over time, while new markets have

opened up for both their sexual and reproductive labor. Commercial Surrogacy for the

domestic and international markets is one such avenue and it is gaining ground in many

urban and semi-urban areas in India today and a huge pool of women from such areas are

eager to act as Surrogates.

The women who engage in Surrogacy are usually poor. They agree to conceive on behalf

of another couple in return for a sum of money that would otherwise take many years to

make. It is important to understand that these women generally do not have many career

prospects as they are predominately uneducated, often engaged in casual work, sometimes

migrants in search of better job opportunities and living in slum areas with inadequate

housing facilities. They come from lower middle class backgrounds, are married, and are

in need of quick money in order to, among other purposes, maintain their families, buy a

house or pay for the children‘s higher education or to settle up a business for her

unemployed, drunkard husband. The need for money is often felt so deeply that childless

couples often negotiate a better price as a result of the competition.

~ 209 ~

There is a growing demand for fair-skinned, educated young women to become Surrogate

mothers for foreign couples. Nevertheless, reasons for foreigners coming to India in search

of Surrogate mothers vary, but the easy availability of women acting as Surrogates in

abundance is another very important factor responsible for attracting international clients.

Women from lower socio-economic backgrounds readily agree to become a Surrogate

mother in India in return for payment, as hiring a surrogate in the western countries12 is not

only difficult, but, the treatment is also immensely costly.

Abundant Choice of Donors [

India is fast becoming the hub for IVF and Surrogacy as the country’s market value is

expected to touch INR 14.2 Billion and register a CAGR of 14 percent approximately over

the next five years. India has witnessed an unprecedented and unregulated growth of

IVF/Infertility/Assisted Reproduction Technology (ART) clinics and hospitals. With the

estimated number of around 3,000 fertility clinics across the country and new clinics being

added every day, India has occupied a place of prominence on the world IVF map.

The present boom, witnessed by the IVF segment, is a result of various factors. The easy

availability of Surrogate Mother, Gamete Donors and Low-cost Infertility Treatments have

made India a favoured destination for Reproductive Medical Tourism or better known as

Fertility Tourism.13 During the fertility treatment the Prospective parents need to honestly

look for a reasonable Donor. The donor can be known, such as the Prospective Mother's

Husband or a friend. He might be an anonymous or "willing to be known" donor to a

sperm bank.

__________________________________________________

12 Shuriah Niazi, Surrogacy Boom, October 14, 2007, by arrangement with WFS, Source: http://www.boloji.com/wfs6/wfs1027.htm

13 Elets News Network (ENN), India’s baby making business: The Growth Story, August 2014, available at http://ehealth.eletsonline. com/2014/08/indias-baby-making-business-growth-story/

~ 210 ~

Many Prospective Parents work with sperm banks because the donors generally cannot

seek legal parental rights, such as visitation. Others are comfortable with, for example, a

donor who plays an uncle-like role in the child's life. Whatever boundaries the parents and

the law draw, however much or little contact he has with the child, the donor will be a

lifelong presence within any AI-created family. Even when happy about their upbringings,

most AI-conceived people are curious about their Biological Fathers. And therefore the

selection of donor is a crucial part in Surrogacy.

The would-be parents from the Indian Diaspora in the US, UK and Canada, and Foreigners

from Malaysia, the United Arab Emirates (UAE), Afghanistan, Indonesia, Uzbekistan,

Pakistan and Nepal are descending on sperm banks and In-Vitro Fertilization (IVF)

Centre’s in India looking for the South Asian genetic traits of perfect sperm donors.14

There is an abundant choice of donors with similar racial attributes available in India. This

is another very important factor contributing to the Surrogacy industry of India.

Lack of Regulatory laws

India has surreptitiously become the booming centre of a fertility market with its

‘Reproductive Tourism’ industry. Assisted Reproductive Technology (ART), as it is

clinically known, has been in vogue in India since 1978. The ‘Rent a Womb’ industry in

India is witnessing a boom, with infertility affecting one in every six couples.

Commercial Surrogacy, of which Gujarat is a known hub, was legalised in India in

2002. In India, while the exact numbers are not recorded, guess estimates put the number

of children born to Surrogates at 25,000, with 50 per cent of the clients coming from the

West. _______________________________________________

14 Anil Malhotra & Ranjit Malhotra, All aboard for the fertility express, Commonwealth Law Bulletin, 38:1, 31-41, (2012) DOI:

10.1080/03050718.2012.646733 http://dx.doi.org/10.1080/03050718.2012.646733

~ 211 ~

Accepting that India is fast being recognized as an “Attractive Option” for Commercial

Surrogacy centre, human rights activists maintain that while Commercial Surrogacy in

itself is welcome “Where persons unable to have children are aided by willing Surrogates

to have their biological children, problem comes in due to the exploitative nature of the

business and lack of regulation in the industry”.

If we talk about the Surrogacy laws in other nations, in Canada, Surrogate Mothers are not

allowed to accept payment but unfortunately this has driven the practice underground.

In Japan, it is the woman who delivers the baby, and not the woman who provides the

eggs, who is considered the Baby’s Mother in a Surrogate birth. In Australia not all states

have laws on Surrogacy but the ones that do are Queensland, where Surrogacy is illegal,

Tasmania where it is an offence to make or receive payment for Surrogacy and contracts

are not legally binding, and in South Australia and Victoria where Surrogacy contracts are

illegal. In South Africa, paying Surrogate mothers is illegal.15 Thus in maximum

countries Surrogacy is considered to be illegal and therefore many infertile couples from

west turn towards India for Surrogacy as in India it has been legalize in 2002 by

Supreme Court but still it is much unregulated.

India has become a Paradise of Surrogacy, but, the fact remains that it is still unlegislated

and largely unregulated, despite being judicially recognized. This is one of the reasons of

so many foreigners coming to India for Surrogacy. In India, the IVF market is largely

monopolized by small niche players and sole-practitioners, as the loose regulatory

environment is promoting constant mushrooming of such players. The IVF industry in

India is completely unregulated. Anyone can open an infertility or Assisted Reproductive

Technology (ART) clinic and start performing procedures the same day, as there is a lack

of centralized regulatory body with complete visibility over the whole market.

_____________________________________________

15 http://nitawriter.wordpress.com

~ 212 ~

Although the Indian Council of Medical Research (ICMR) reports 3,000 clinics

particularly dealing in Surrogacy around the country, certain market forecasters estimate

that there could be as many as 15,000 sole practitioners who focus on Surrogacy only.

Currently, the industry stick to guidelines set out by the ICMR that includes when, and by

whom IVF can be performed. The guidelines do not lay down any rules for the setting up

of ART clinics, Compensation to be paid to the Surrogates, no. of Embryos to be

implanted in the Surrogate etc. And this is the reason why infertile couples from across the

globe are turning to India.

In India Surrogacy is legalized but unregulated and therefore the medical practitioners are

involved into Mal Practices. It is observed that in maximum Surrogacy arrangements

Surrogates are considered as objects and attention is paid only to the desires of Intended

Parents. The Medical practitioners and even the guidelines of ICMR seem to support the

desirous couples. There is no Monitoring of the ART Clinics.

Clinics function in tight cliques, with unrelated centre’s like Dental Clinics sometimes

assisting Fertility Clinics. Although there are no fixed rules related to the amount of

compensation for the Surrogate Mother, it is arbitrarily decided by the clinics. Often the

woman who delivers the baby is paid very less for it. Though the couple who wants to

have a baby through Surrogate mothers pays anything between Rs.2 lakh and Rs.5 lakh to

agents, the woman Dr who delivers the baby gets only Rs.75, 000 to Rs. 1 lakh.

“No fixed compensation structure, no laws that cater to the health and number of births

that a surrogate can support and usually incomplete advertisements of the services by

medical establishments work against the interest of the women involved in the case”.16

_________________________________________________ 16 B. S. Perappadan, Clamour grows for stringent regulation of surrogacy, THE HINDU, (New Delhi edn., August 25, 2014 ) available at http://www.thehindu.com/news/cities/Delhi/clamour-grows-for-stringent-regulation-of-surrogacy/article6348956.ece

Dr. Ranjana Kumari, Director, the Centre for Social Research says:

~ 213 ~

Fertility experts are also concerned that ICMR guidelines, which say that Surrogates can

be implanted with a maximum of three embryos, are being flouted. Fertility Doctor

Kaushal Kadam, at the Corion Fertility Clinic in Mumbai, says that she knows of some

Indian clinics that implant Surrogates with more than they should, one clinic reportedly

with five or six embryos. Kadam's assertion was borne out in numerous conversations that

the researcher had with fertility experts in India. Gillian Lockwood, medical director of

the Midland Fertility Services, West Midlands, UK, which deals with Surrogacy, is

shocked that doctors would implant such “Dangerously high numbers of Embryos”. For

Surrogate mothers, she says, “there is already an increased risk due to the immune

mismatch, which can lead to conditions like pre-eclampsia or gestational diabetes”.17

Implanting so many embryos increases the risk of multiple births, which have substantial

health risks. Even a twin pregnancy strains organs such as the liver, kidneys, and thyroid.

Multiple births can mean babies are born prematurely, which leaves them at a higher risk

for health problems later on in life. Ironically, Prospective Parents might view implanting

high numbers of embryos as a good thing. For “many couples, if they see this is their only

chance for a family, adopt a sort of buy one, get one free approach. Given that it doesn't

cost any more to have a Surrogate Mother have twins for you, they can sometimes see it as

a weird economy of scale.

Bobby Bains, who with his wife Nikki, has now had two children through Surrogates in

India, revealed that Surrogacy in India worked out so much cheaper precisely because

clinics implant more than the two embryos that is standard in the UK. In one of their

Surrogacy attempts in 2007, their potential Surrogate was implanted with six embryos.

Thus, the lack of regulation in the process of Surrogacy in India is being capitalized by the

Medical practitioners for earning huge profits by supporting the Intended parents

especially from west as in their countries either Surrogacy is banned or is under strict

monitoring of the Government.

_____________________________________________________ 17 Supra note 11

~ 214 ~

Expertise Medical Services

Surrogacy and ART offer solutions to infertility. The existing demand for these services

distorts priorities in the organization of health-care services as pressure is built to set up hi-

tech reproductive techniques within open markets and public sector service infrastructure

without building the basic facilities that help to prevent the infertility. The poor have to

either sell their assets to access the facilities or use the opportunity to earn by selling their

own reproductive potential the women that are pushed into this process carry the maximum

risks to their health. Over the past 10 years or so, our country has seen a mushrooming of

fertility clinics. This has inspired the medical tourism, where Surrogacy has important

place in its list of attraction as couples from abroad come seeking easy access to Surrogate

mothers. According to private providers, first world comforts and quality is available at

these Indian Institutions at the third world prices.

A 2012 study by the Confederation of Indian Industry estimated that nearly 10,000 foreign

couples visit India yearly for reproductive services and nearly 30% are either single or

homosexual.18 The relatively low cost involved an average Surrogacy package costs almost

50% less as compared to other countries, easy availability of a large pool of Surrogates,

good medical infrastructure with more than 2 lakh IVF clinics and legal freedom which

does not restrict single, gay or unmarried couples from availing this form of ART, has

taken India to spiraling heights in the field of International Surrogacy. These factors have

pushed the Surrogacy beyond its legitimate place. The technology which has evolved to

give the joy of parenthood to infertile couples has now become a business leaving behind

the traditional values and ethics. In India, IVF treatment is available at an affordable cost

which is nearly one-quarter of the cost in developed nations. Fertility clinics in countries

like UK, Israel, Australia, France, Spain, and Denmark are finding it more and more

difficult to fulfill the demand for donor eggs and hence turning to India. Furthermore, India

is also home to some of the finest International IVF Centres and top-notch IVF Doctors. ________________________________________________

18 Krishnan V. India’s draft surrogacy bill bars homosexuals, live-in couples. http://www.livemint.com Politics /ZsS2zs7Kvq Hlk4FCgu W0EN/Draft-surrogacy-Bill-bars-homosexuals-livein-couples.html (Last accessed August 26, 2013)

~ 215 ~

Most of the major global IVF stakeholders have recognized the size of this opportunity,

and some have already entered the market. For instance, a renowned UK IVF operator,

Bourn Hall has established its two clinics in Gurgaon and Kochi. Despite this monumental

growth and expansion, the IVF sector is not without a catch. There are glitches, pitfalls and

dilemmas which can prove to be deleterious for its growth in the long run.

But while such circumstantial ambiguities persist, on the medical side, with internationally

trained Indian doctors, state-of-the-art facilities, high end diagnostics, thoroughly screened

Surrogates and qualified staff, the multi-million dollar Indian Surrogacy industry could

well turn out to be the largest in the world. Young doctors studied from top medical

colleges are providing their services in Surrogacy Clinics. The Indian Fertility Clinics are

running without any regulation and are not even following the ICMR guidelines properly

as there is no monitoring authority at National and State level. Because of lack of

regulation the medical experts are supporting the intended parents in return of huge profits.

Hence, the world class Medical amenities and Hi- tech Medical Infrastructure with

Expert Medical Practitioners and Services available in India are another very prominent

factors augmenting fertility tourism in India.

Supportive Machinery

With the globalization of trade in services, and the rise in Medical Tourism, India has

emerged as an attractive destination for medical services, and more recently, reproductive

services. As corporatized health care pushes Medical Tourism, the Indian state is also

extending its support to this burgeoning sector. For the last few years, India’s ‘Fertility

Industry’ has experienced rapid expansion, with the country emerging as one of the leading

Global Destinations for ‘Fertility Tourism’ or ‘Reproductive Tourism’ today.

~ 216 ~

In India, Assisted Reproductive Technologies (ARTs), including for Surrogacy, have

achieved the proportions of an industry. Multiple Factors drive the demand for Surrogacy

in India. Out of them one such factor is the Supportive Machinery for Surrogacy available

in India.

Commercial Surrogacy for the domestic and international markets is the new avenue and it

is gaining ground in many urban and semi-urban areas in India today at an alarming rate.

Many ART clinics in India have tied up with foreign hospitals and agencies to solicit

‘clients’ globally in a bid to expand their clientele. These are included in the Medical

Tourism Services that are supported and incentivized under international agreements such

as the General Agreement on Trade in Services (GATS) under the World Trade

Organization (WTO).

The industry functions through actors and collaborators at various levels, in an

environment characterized by lack of binding standards or regulations, where these

multiple stakeholders stand to profit enormously. ART clinics are not the only players in

the business of promoting ‘Reproductive Tourism’ in India. Other players include a wide

array of organizations catering to clientele both at the national and international levels.

These range from ART consultants, medical tour operators, surrogacy agents, the

~ 217 ~

hospitality industry, and tourism departments to other organizations specializing in the

promotion of medical tourism. The Indian Government promotes medical tourism by

offering incentives such as low interest rates for loans provided for establishing hospitals

and subsidized rates for buying drugs, importing equipment, and buying land for clinics. In

addition, the General Agreement in Trade in Services (GATS) includes trade in medical

services, thus enabling private hospitals treating foreign patients to receive financial

incentives; these incentives include the ability to raise capital at low interest rates and the

eligibility for importing medical equipment at low rates of duty.

As Qadeer and Reddy assert, Medical tourism is an industry that thrives on cheap air

fares, Internet and communication channels in developing countries, and hi-tech super-

specialty medical services for people who can afford it, whether foreign or national

medical tourists. It also effectively deploys and markets Indian exotica, and packages

health care along with other traditional therapies and treatment methods.

To create demand, ART providers argue that with infertility being ‘Rampant and rising

steadily’ in today’s world, ARTs have become the ‘need of the hour’. They cite higher

rates of infections and ensuing complications, particularly in the absence of adequate

Gynaecological and Obstetric services, as factors that contribute to the high levels of

infertility in India. Providers thus claim that they are merely responding to the demand of

women ‘desperate’ to become mothers. There is an increasing medicalization and

pathologization of the condition of infertility, with the industry pushing for early medical

intervention.

The medical practice is motivated most by the need to keep up the ‘Success Rate’ and to

ensure the satisfaction of the Commissioning Parents, wherein the rights of the Surrogates

do not feature as a concern. Various studies revealed that several decisions taken in the

course of the treatment” such as those of opting for IVF in all cases, transferring multiple

embryos, performing foetal reduction, deciding on the time of delivery and preference for

~ 218 ~

caesarean sections, denying Surrogates to breast feed, are motivated by the concern for

ensuring conception and relinquishment on the terms of the Commissioning Parents. The

fact that these decisions translate often into unnecessary invasive procedures, can result in

lasting effects on the body has no bearing. Of equal significance is the fact that while such

decisions are supported by the Commissioning Parents’ intent as well as payments for the

“treatment”, Surrogates may find themselves left to their own selves and resources when it

comes to facing and dealing with health consequences post-pregnancy.

Privileging the financial interests over considerations of Surrogates’ health, while evading

any scrutiny by grounding all decisions in being “Medically indicated”, poses a great

challenge to ethics of medical practice, where “treatment” for one party, infertile couples

can come at the expense of health and participation of the Surrogate, who lacks the

privileged status of the client. The process lacks any transparency and the use of

technology, and the rationale for it, is seen to take into account the wishes of the

Commissioning Parents. Such skewed priorities and decisions in provisioning healthcare

are not surprising when the channel is that of profit-run, private enterprises that are more

concerned with the satisfaction of their ‘Consumers’ and stand completely unaccountable.

The Commercial Surrogacy arrangement is located in health care settings characterized

largely by private profit-oriented centres and hospitals offering services for infertility,

including Surrogacy. In this scenario, the Commissioning Parents have the power to set the

terms of the Surrogacy arrangement; their position as ‘Paying Customers’ for the services

accessed is accepted as legitimate and thus privileged. This creates a perception of the

Surrogate as merely an appendage to the Commissioning Parents. This is further amplified

by the class differences that characterize the arrangements, with Surrogates being able to

enter the spaces of these facilities by virtue of being Surrogates, spaces that are otherwise

inaccessible to and unaffordable for them. The health care extended to them is conditional

on their role as Surrogates and on the health of the children to be born through Surrogacy.

In such setups, the administration and providers are left completely unsupervised and

~ 219 ~

unaccountable for situations when decisions are taken at the expense of the health of the

Surrogate. The inferior status of Surrogates in the Surrogacy arrangement is evident from

the process of information transaction, which is largely under the control of

Commissioning Parents, Hospitals, and agents. Access to, and flow of, information and

participation in the decision-making process are predicated on the hierarchies of

knowledge, expertise and class that structure the Surrogacy arrangement.

The contract and the process of ‘Counseling’ are tools designed to serve the interests of the

Commissioning parents, the Hospitals and the Surrogacy industry. In current practice, the

contract does not embody the interests and conditions of the arrangements and are not set

by all ‘parties’ equally. It is merely an affidavit signed by the Surrogate agreeing to hand

over the child after birth and to relinquish all rights over the child. Nor are all the ‘parties’

obligated equally through this contract, resulting in an extremely biased contractual

agreement. ‘COUNSELING’, too, is practiced as an informal interaction between

Surrogates and Doctors/Agents. It is aimed at building a particular perspective among

Surrogates that is designed to ‘Convince’ them initially of the benevolence of becoming

Surrogates, and thereafter of the need to relinquish the child.

The practice is also seen to reflect compliance with, and the strengthening of, the

prevailing social hierarchies by catering to the demand for specific oocytes, to the demand

for specific kinds of women as Surrogates based on caste, religion, or class identity, and to

the demand for practices of selecting embryos on the basis of sex or against disability. In

nutshell, in India the Surrogacy industry and especially the infertile couples are supported

by numerous actors such as Surrogacy Clinics, Surrogacy Hostels, Agents, Surrogacy

Centers, top class Medical Practitioners, various Hospitals, Legal Practitioners, Medical

Tour Operators, Indian Tourism Department etc. This is again one of the major reason of

the growing Surrogacy industry in India as it is very easy and convenient for infertile

couples to come down to India and have their own Genetic Child with the help of the

available Support System.

~ 220 ~

Scenario in Special Reference to Few Indian States

Infertility is a problem faced by couples worldwide.19 In the United States an estimated 6.1

million women between the ages of fifteen and forty-four have an impaired ability to

conceive children;20 in Australia, an estimated 1 in 6 couples between the ages of twenty

and fifty suffer from infertility;21 in Canada an estimated 600,000 people are dealing with

infertility;22 and these rates could double in the decade to come.23 Partly because of these

staggering statistics relating to infertility, the field of assisted reproduction-which includes

egg donation, intrauterine fertilization, In-Vitro insemination, embryo screening, and

surrogacy24 has grown astoundingly in the past three decades. Of these Assisted

Reproductive Techniques, Surrogacy is arguably the most controversial.

The concept of Surrogacy in India is not new. Commercial Surrogacy or "Womb for rent,"

is a growing business in India. In India, English speaking environment and cheaper

services attract the willing clients. Future projections of Surrogacy practice range from

opportunity to exploitation - from rural women in India uplifted out of poverty to a

futuristic nightmare of developing country baby farm.

_____________________________________________________

19 Marcia c. Inhorn, Local Babies, Global Science: Gender, Religion And In-Vitro Fertilzation In Egypt, (2003) ("Infertility is a global health issue that affects millions of people worldwide."). 20 Joyce c. abma et al., Health statistics, fertility, family planning, and women's health: NEW DATA FROM THE 1995 NATIONAL SURVEY OF FAMILY GROWTH 7 (1997) (noting that in 1995, 6.1 million women of reproductive age had "impaired fecundity," meaning "difficult or impossible to get pregnant or carry a baby to term"). 21 Hearing Before the Standing Comm. on Health and Ageing, H.R., Commonwealth of Australia 6 (July 6, 2005) (statement of Professor Michael Chapman, Chairman, IVF Directors Group) 22 The Infertility Awareness Association ofCanada, http://www.iaac.ca/en/home (last visited Mar. 5, 2009). 23 See Alex Barnum, Forlnfertile Couples, It's California or Bust: State Has Become Major Destination for Making Babies, S.F. CHRON., Aug. 15, 2005, at Al (noting estimates that infertility in industrialized European nations could double in the next decade). 24 John A. Robertson, Commerce andRegulation in the AssistedReproduction Industry, 85 TEx. L. REV. 665, 665 (2007) (book review); Jami L. Zehr, Student Article, Using Gestational Surrogacy and Pre-Implantation Genetic Diagnosis: Are Intended Parents Now Manufacturing the Idyllic Infant?, 20 LOY. CONSUMER L. REV. 294, 296 (2008); see CHARLES P. KINDREGAN, JR. & MAUREEN McBRIEN, ASSISTED REPRODUCTIVE TECHNOLOGY: A LAWYER'S GUIDE TO EMERGING LAW AND SCIENCE 8-10 (2006) (listing examples of uses of assisted reproduction technology).

~ 221 ~

In case of Surrogacy in India, it is hard to tell that whether these women are exercising

their own personal rights or whether they are forced to become Surrogate Mothers due to

their mother-in-law's or husband's desire to fulfill material and financial needs.25

Opponents of Surrogacy argue that the practice is equivalent to prostitution and by virtue

of that similarity; it should be disallowed on moral grounds. Surrogacy contracts are

dehumanizing and alienating since they deny the legitimacy of the Surrogate's perspective

on her pregnancy. Surrogate mother tries to avoid developing a special bond with the child

in her and views the pregnancy as merely a way to earn the much-needed money. The

payment for bodily services dehumanizes the Surrogate mother and exploits her

reproductive organs and capability for personal gains of the wealthy.

Commercialization of Surrogacy in India has created several social conflicts. Given the

extreme vulnerability, one-third of the Indian women due to poverty, exclusion from and

marginalization in labor and job markets, patriarchal social and family structures and low

educational levels, the financial gain through Surrogacy become a key push factor. Since

most Surrogate mothers are not from well-off sections and the motive primarily is

monetary so they are easily exploited by the agents working for Commissioning Parents.

Secrecy and anonymity creates a negative environment that affects human relations within

and outside families. In General this is the status of Surrogacy in India. Now let us discuss

the Social Scenario of Surrogacy in reference to some particular states which are as

following:

Gujarat Maharashtra Rajasthan Madhya Pradesh

_______________________________________________

25 Surrogate Motherhood in India, available at http://web.stanford.edu/group/womenscourage/Surrogacy/

GUJARAT

~ 222 ~

For almost all Indians, the family is the most important social unit. Till as recently as a

couple of years ago, infertility was a glaring phenomenon that proved to be a shattering

experience for many couples. In the Indian family milieu, mothers-in law and intrusive

relatives would cast aspersions and make sly innuendoes on couples for not being able to

have kids in the first few years of marriage. Irrespective of their socio-economic status and

the caste or community they belong to, infertile couples are outcaste and discriminated

against.

However, with the Advancement of Science and Technology, a lot of things have changed

for the better. Right from changing our old mindsets to motivating us to explore newer,

more successful ways to live our life, technology has made things possible which weren’t

so before. The wonder of IVF is one such example which has come as a boon to millions

of couples who face the scourge of infertility like a thorn in the flesh.26 Over the last two

decades, there has been an exponential growth of infertility clinics around the world. The

concept of IVF has gained popularity at a swift pace in India over the last decade.

____________________________________________________________

26 India’s baby making business: The Growth Story, ehealth – The enterprise of Healthcare, August 9, 2014

http://ehealth.eletsonline. com /2014/08/indias-baby-

making-business-growth-story/

Currently, India’s

fertility market is

witnessing double-

digit growth which

is driven by proliferating infertility rates amongst married couples and availability

of competitive treatment procedures.IVF, Intrauterine Insemination (IUI) or Artificial

Insemination by husband or donor sperm, egg freezing, Intra cytoplasmic sperm injection

(ICSI), donor egg treatment, donor embryo treatment, endoscopic diagnosis as well as

~ 223 ~

surrogacy is all practiced widely in India with new techniques being evolved and

developed on a par with international standards. Sperm donation is a recent development

in Indian fertility market. It requires a kind of a medical expertise that is being expanded

and spread throughout.

Today, India stands at the forefront of reproductive medicine and Gujarat is touted as a

MECCA for all the IVF treatments. The presence of many IVF clinics and high

availability of Surrogates in Gujarat has ensured that Surrogacy has picked up majorly in

Gujarat, especially in Anand, which has earned the reputation of a ‘Baby Farm’.27

Anand, a small district in Gujarat, is home to India's first milk co-operative Amul

movement empowering scores of women, but since 2007 it is scripting a very different

story. Now it is considered to be the country’s Surrogacy capital. Anand is a city of about

100,000 people in the western Indian state of Gujarat. A curious fact about the

demographics of the state of Gujarat is that a large percentage of Guajarati’s have settled in

different parts of the world. Of the 20 million Indians spread across the globe, 6 million are

from the state of Gujarat, meaning that nearly 30 percent of the total Non-Resident Indian

(NRI) population is from this one state.28 Non-Resident Guajarati’s (NRGs) coming to

India for personal and medical visits are making Gujarat one of the most popular sites for

medical tourism in India.

________________________________________________

27 Lakshmi Ajay, Gujarat, a hub of rent-a- womb industry in India , The Indian Express, Nation, February 13, 2014, New Delhi available at http://indianexpress.com/article/india/india-others/gujarat-a-hub-of-rent-a-womb-industry-in-india/ 28 Pande A., Commercial Surrogacy in India: Manufacturing a Perfect Mother-Worker, : Journal of Women in Culture and Society 2010, vol. 35, no. 4 Available at http://www.iss.nl/fileadmin/ASSETS/iss/Guests/Adoption___surrogacy /Publications/Amrita _Pande _Pub.pdf

The majority of medical tourists are cardiac patients, but an increasing number of patients

are coming for joint replacement, plastic surgery, and now in vitro fertilization and

Surrogacy. Dr Nayana Patel is considered to be the Founder of Surrogacy industry in India

and especially Gujarat where she runs her infertility clinic named as “AKANKSHA

CLINIC”. Akanksha infertility and IVF clinic at “KAIVAL HOSPITAL ” in Anand has

~ 224 ~

come in existence to give a helping hand with modern techniques to many infertile

couples. The center is well established and has in recent years achieved some of the best

result. The center is now recognized internationally for its IVF and Surrogacy services. Dr.

Nayna Patel, Medical director of this centre has passed her MBBS and MD with five

gold medals. She has attended the scientific programme and IVF workshops at National

University, Singapore in 1996, and has been to IVF centers in USA, South Korea, UK etc.

She has received extensive training for all these techniques.29

Dr. Nayna Patel with her contracted Surrogates

Dr. Nayna Patel says, "Human beings have two main instincts; the instinct of self-

protection and the instinct to reproduce." And she should know – she has carved out a

career matching infertile couples with women willing to "Rent their Wombs". Beginning

with a couple of Surrogacy’s a year in 2003, Patel's Akanksha clinic in the West Indian

state of Gujarat now delivers about 250 Surrogate babies a year. ________________________________________________ 29 http://ivf-surrogate.com/

For now, however, it's business as usual at the Akanksha clinic. The researcher observed

that When Patel arrives at her clinic, the lobby is full of women. Some wear brightly

coloured saris; are in western dress. They are either desperately seeking a baby or hoping

to lift themselves out of poverty and offer their own children a better life. At the clinic of

~ 225 ~

Nayna Patel, perhaps India’s best-known “Surrogate Doctor” who delivered Anand town’s

first Surrogate baby, more women’s are signing up to be Surrogates, with even nurses and

teachers lining up, as their husbands lose their jobs.” The women who come here usually

want the money to buy a home, pay off loans, or for their childrens’ college education,”

said Patel in her small clinic, the walls of which are covered with clippings and pictures of

Patel with babies and parents.

It all began with a Grandmother Surrogate for a UK couple in 2004 that pitched Anand and

Patel into the spotlight. Following their lead, locals and foreigners began to flock to Patel’s

clinic, drawn by the lower costs, relaxed attitude toward Surrogates and lack of legislation.

Dr. Patel, was featured on a special show on Oprah Winfrey 7 years ago, raised her voice

in defence.

“My argument is: the Surrogate is not killing anyone, not committing an illegal

or immoral act. And if a Surrogate’s child is able to get an education, if one

family is able to buy a home — and help a needy couple in the process, where is

the harm?”30

A Surrogate is generally paid about Rs250, 000-400,000 ($4,000-$8,000), a huge sum of

money in a country where many live on less than $2 a day. Many women, who come from

different areas, have found employment in the In-Vitro Fertilisation (IVF) clinic in Kaival

Hospital run by Dr Nayna Ben Patel. To them she was like a Godmother and the Mother of

Surrogacy in India.

________________________________________ 30 Chandran R., Poverty makes surrogates of women in Gujarat , Live Mint, Apr 24,2009 , available at http://www.livemint.com /Politics /F7XhxvREB6TKZo3ybQiISJ/Poverty-makes-surrogates-of-women-in-Gujarat.html

Dr. Nayna says that "I would like to help them all throughout my life and the way we are

trying to build up this support group for the surrogates and build up a fund for the

surrogates."31 Couples from western countries come to Dr Patel’s Clinic with a hope of

~ 226 ~

having their own Child. Looking into the concern of the Intended parents she has

established a Surrogate House for 24*7 monitoring the Surrogates.

Raju bai's is a familiar story in the "Surrogate House" where she lives with 39 other

pregnant women. Owned by Patel, the house is located 10 minutes away from the clinic.

With two to three iron-framed beds in each room, the house has the look of a hospital

ward. The Surrogates, clad in loose, colourful gowns, are sitting, lying, stretching,

watching TV or chatting with each other. In one room, hangs a picture of a crawling

toddler with the words: "The time to be happy is now." The majority of the women are

second-time Surrogates and will have caesarean sections. "We have to cut our stomachs for

money," says Anjuman Pathan, a blunt, 30-year-old. "It's not a bad thing, is it?"32

Life at the Surrogate House creates a sense of sisterhood. The women enjoy the rest and

care they may not have had during their own pregnancies but are confined to the house for

the whole pregnancy. Their families can visit on Sundays but the Surrogates only leave the

premises for medical check-ups or if there is a family emergency.Thus, its docile here to

say that initially Doctors with western education, top-notch facilities and lower prices had

already made India an attractive destination for procedures ranging from bypass surgery to

liposuction. And now, Lax Legislation and an entrepreneurial streak in Gujarat have helped

make Anand a last stop for many childless couples at home and abroad. In this bustling

town known for India’s best-known brand of butter, Patel has delivered more than 600

Surrogate babies, 40% for Indians living abroad and 20% for foreigners.

________________________________________________ 31 Bhardwaj R., India preferred destination for surrogacy due to low cost, but practice remains unregulated, CNN-IBN, Oct 18, 2014 available at http://ibnlive.in.com/news/india-preferred-destination-for-surrogacy-due-to-low-cost-but-practice-remains-unregulated /506888-3-238.html 32 Inside India's surrogacy industry , December 06, 2011 Available at http://www.theguardian.com /world /2011 /dec /06 /surrogate-mothers-india

Apart from Akanksha Clinic, Gujarat is now a hub of hundreds of other IVF Clinics.

Out of them one such Clinic is Hope Maternity Clinic. At Hope Maternity Clinic in

Anand, it was observed that the proportion of international clients was the clear indication

of the success of medical tourism. Hope Maternity Clinic is very unremarkable looking: it

~ 227 ~

is one clinic among the many mushrooming medical stores and hospitals lined up one after

the other on a street in the center of the city.

Dr. Usha Khanderia, Medical Director of the Center, specializes in infertility and

assisted reproductive technologies. She had her first successful case of Surrogacy in 2004

when a woman gave birth to her own Grandchildren on behalf of her UK- based daughter.

For her second case, Khanderia convinced an employee at her clinic to be a Surrogate.

Since then she has matched over 100 Surrogates with couples from India and from places

as diverse as the United States, Taiwan, South Korea, South Africa, the United Kingdom,

and Spain.33 In nutshell, in Gujarat Surrogacy has turned to be a booming business.

Infertile Couples from abroad come to Gujarat with a hope of having their own Genetic

child and therefore there is a mushroom growth of IVF Clinics in Gujarat particularly in

Anand, Surat, Ahmedabad etc. Following is the list of few very popular clinics of

Gujarat.34,35

IVF CLINICS IN GUJARAT

Akanksha Infertility Clinic 91-2692-253789

Dr Nayana Patel,

Kaival Hospital, Station Road

Anand, Gujarat, 388001.

Email: nayana@ivfsurrogate.com

Web: www.ivfcharotar.com [

_________________________________________ 33 Supra note 28 34 IVF Centres in Ahmedabad, In Vitro Fertilization Treatment, India Justdial http://www.justdial.com/Ahmedabad/ivf-centres, 35 Clinic locator, http://www.fertilityjourney.in/locator/clinic.asp?C=99152420668499421296&search Type=&page=&do Search=True &State=Gujarat

Motherhood Women And Child (91)-79-30492250

Surgen Arcade, First Floor, Sola, Ahmedabad - 380063,

Above Axis Bank, Near Science City

Estd. in 2012

~ 228 ~

Nautam Nursing Home (91)-79-30247826

Rasala Marg, Ellis Bridge, Ahmedabad - 380006,

Near Mithakali Six Roads

Estd. in 1976

Boon IVF Center (91)-79-30925070

2, Sumangalam Society, Drive In Road, Ahmedabad - 380052,

Near HDFC Bank, Opposite Drive In Cinema

Estd. in 2013

Pratham Ivf & Urology Clinic

(91)-79-30925164

131, 132,135, 136, First Floor, Advait Complex,

Vastrapur, Ahmedabad - 380015, Near Sandesh Press

Estd. in 2003

Dev Art IVF and Shachi Women

(91)-79-30495687

First Floor, Kaveri Complex, Subhash Bridge, Ahmedabad - 380027,

Opposite RTO Office, Subhash Bridge Circle

Estd. in 1992

Sarvamangal IVF and Womens

(91)-79-30247946

301 & 303, 3rd Floor, Jyoti Complex, 132 Feet T Ring Road, Satellite, Ahmedabad - 380015,

Beside Dr Parekh Hospital

Estd. in 1996

Nova Pulse Ivf Clinic Pvt Ltd

(91)-79-30234767

108, Swastik Society, H L Commerce College Six Road, Navrangpura, Ahmedabad - 380009,

Behind St Xaviers Ladies Hostel And Sams Pizza

Estd. in 2000

Wings Womens Hospital

~ 229 ~

(91)-79-30931756

2, Sumangalam Society, Thaltej, Ahmedabad - 380054,

Opposite Drive In Cinema , Near HDFC Bank

Estd. in 2006

Jani Nursing Home

(91)-79-30932477

7 A , Urmikunj Society, Navrangpura, Ahmedabad - 380009,

Nr St Xavier's College Corner, B/H Bank Of Baroda

Estd. in 1982

Vani Ivf Centre And Hospital

(91)-79-30492214

Vani Hospital, 32 Asmita Society, Maninagar, Ahmedabad - 380008,

Near Kashivishwanath Temple, Maninagar East

Estd. in 1994

Tulip Womens Hospital

(91)-79-30247371

Kalatirth Complex, Satellite, Ahmedabad - 380015,

Above HDFC Bank, Near Prernatirth Derasar, Jodhpur

Estd. in 2001

Vijaya Maternity And Surgical Hospital

(91)-79-30922375

Second Floor, Chanakya Plaza, New C G Road-Chandkheda, Ahmedabad - 382424,

Opposite Swagat 1 Bunglows/ICICI Bank

Estd. in 2007

Reshambai Fertility Hospital

(91)-79-30234768

Swastik Complex, First Floor, Shahibaug, Ahmedabad - 380004,

Opposite Rajasthan Hospital

Estd. in 1996

Lifeline Multispeciality Hospital

(91)-79-30925752

Shayona Tilak, New S G Road, Chandlodiya, Ahmedabad - 380061,

~ 230 ~

Near Vandemataram Arcade

Estd. in 2013

Rosemaarry Womens Hospital

(91)-79-33014099

29 & 30, B Block, Mansi Complex, Premchand Nagar Road, Vastrapur, Ahmedabad - 380015,

Opposite Satellite Tower

Estd. in 1994

Sushrusha Navneet Memorial

(91)-79-30817141

Sushrusha Hospital, Navrangpura, Ahmedabad - 380009,

In a Lane Opposite Navrangpura Telephone Exchange Building Near Sardar Patel Seva Samaj Hall

Estd. in 1991

Shashwat Ivf Center Pvt Ltd

(91)-79-30236020

Second Floor, Nilkanth Palace, Prahladnagar Road, Satellite, Ahmedabad - 380015,

Opposite Seema Hall

Estd. in 1997

Sunflower Womens Hospital

(91)-79-30492423

132 Feet Ring Road, Memnagar, Ahmedabad - 380052,

Near Manav Mandir, Opposite Helmet Circle

Estd. in 2004

Palash Hospital

(91)-79-30247913

14 C P Nagar Society Part 1, Bhuyangdev, Ahmedabad - 380052,

Bhuyangdev Cross Road

Estd. in 2010

Mayflower Womens Hospital

(91)-79-30817167

Mayflower House, 132 Feet Ring Road Drive In Road, Memnagar, Ahmedabad - 380052,

Opposite Traffic Police Halmet, Near Manavmandir

Estd. in 2003

~ 231 ~

Anand Surgical Hospital Pvt Ltd

(91)-79-22815100, (91)-9727395266

Memco Cross Road, Memco, Ahmedabad - 380025,

Near Ioc Petrol Pump

Estd. in 2014

Bavishi Fertility Institute

(91)-79-30234809

Dr Himanshu Bavishi, Dr.Falguni Bavishi,

Paldi Cross Road, Paldi, Ahmedabad - 380007,

Near Gajrawala Flat Next To Adani CNG Station Opposite Municipal Garden

Email: drhbavishi@gmail.com

Web: www.ivfclinic.com

Nagoris Institute For infertility

(91)-79-26401090, 26402090

Opp Krupa Petrol Pump, Ellis Bridge, Ahmedabad - 380006,

Nr Parimal Garden

Estd. in N/A

Poojan Maternity And Fertility...

(91)-79-22818183, (91)-8460810362

202, 2nd Floor, Shruhad Complex, Devi Multiplex Road, Naroda, Ahmedabad - 382330,

Opposite Anil Showroom, Naroda Doctor House, Narayan Nagar Bus Stand

Estd. in N/A

SHASHWAT IVF CENTRE PVT LTD

(91)-79-26931919, 26930007

2nd Floor, Nilkanth Palace, Prahalad Nagar Road, Satellite, Ahmedabad - 380015,

Opp Seema hall

Estd. in 1996

21st Century Hospital & Test Tube Baby Centre

91-261-2490190

Dr Purnima Nadkarni, Dr.Pooja Nadkarni Singh,

51/B,Dawer Plaza,Near SaveraHotel,Station road Surat, Gujarat, 395003.

Email: surat21st@rediffmail.com

Web: www.nadkarnigroup.com

~ 232 ~

Me & Mummy Hospital & IVF Centre

91-261-2471111 / 0261- 2479731-32-33

Dr Praful Doshi,

3rd Floor, Jainidhi Complex, Opp Bahumali Building, Nanpura Surat, Gujarat, 395001.

Email: meandmummyivf@yahoo.co.in

Web: www.meandmummyindia.com

Pulse Women's Hospital, Melbourne IVF Gujarat

91-79-26422626

Dr Manish Banker, Dr.Pravin Patel,

108, Swastik Society, Bh St Xavier's Ladies Hostel, Navrangpura , Ahmedabad, Gujarat, 380009.

Email: info@pulse-hospital.com, mivfg@yahoo.com

Web: www.pulse-hospital.com

Sunflower Women's Hospital 079-27410080 / 27410090

Dr Raman Patel / Dr.R.G.Patel, Dr.R.G.Patel,

Near Manavmandir, Opp Traffic Police Helmet Cross,

Drive In Road, Memnagar Ahmedabad, Gujarat, 380052.

Email: drrgpatel@sunflowerhospital.in

Web: www.sunflowerhospital.in

MAHARASHTRA

It is now 11 years since Commercial Surrogacy was legalized in the country, mainly to

promote health tourism, but Surrogate Motherhood is yet to gain due recognition. In fact,

Surrogate Mothers are an exploited lot. A study by the Centre for Social Research (CSR)

has found that the women who agree to be Surrogate Mothers get only one or two per cent

of the total money a couple spends to have a child in this manner. The rest of the money is

pocketed by owners of fertility clinics, doctors, nursing homes and middlemen. In fact, the

condition of the Surrogate Mother is worse than that of a slave.

~ 233 ~

She not only has to carry the fertilized egg in her womb for nearly 10 months but is also

kept aloof from her own family. She is often admitted to a secluded place where she has to

eat food and medicines prescribed by doctors, not for her own nourishment but for the

growth of the child in her womb. Logically, she should be the one who must benefit the

most. Surrogacy is no more a small business. The Confederation of Indian Industry has

pegged the volume of such business at `13,800 Crore. Yet, it is almost unregulated leading

to exploitation of women in India and especially in the State of Maharashtra. These are the

views expressed in an article published in The News Indian Express. 36

India is fast turning into a Surrogacy hub for couples desperate to have children. But there

is a flip side - the possibility of exploitation. CNN-IBN takes a look at both sides of what's

being called the fertility industry. "I have big dreams for my children. I want my son to

become an engineer and my daughter to be a doctor," said Kaushal, who is a Surrogate

Mother.37 To realise those dreams, 29-year-old Kaushal, a Mother of two, decided to

become a Surrogate.

_____________________________________________

36 “Eliminate exploitation of surrogate mothers “ The New Indian Express ,2013, 20th July http://www.newindianexpress. com/editorials/Eliminate-exploitation-of-surrogate-mothers/2013/07/20/article1691946.ece

37 India a surrogacy hub despite the flip side, IBN live, 2012, Jun 12 http://ibnlive.in.com/news/india-a-surrogacy-hub-despite-the-flip-side/265568-17.html

The motivation was purely financial. Living in Mumbai on a Rs 150 income for a family of

four, she knows she will be compensated well for carrying someone else's baby to term.

Surrogates are paid between Rs 2 to 4 lakh and for the infertile couple waiting, the gift is

priceless. This is again a story from, Mubai which is leading in Fertility clinics in the State

of Maharashtra.

According to Hrishikesh Pai, a Mumbai-based In-Vitro Fertilization Specialist and

Vice-President of the Indian Society for Assisted Reproduction, India had about 350

facilities that offer Surrogacy as a part of a broader array of infertility-treatment services,

triple the number in 2005. In the year, 2008 Dr. Pai says, about 1,000 pregnancy attempts

~ 234 ~

using Surrogates were made at these clinics. Next year, the figure jumped to 1,500, with

about a third of those made on behalf of parents from outside India who hired Surrogates.38

Rudy Rupak, President of Planet Hospital, a California-based Medical-Tourism

company, says that in the first eight months of 2009 he sent 600 couples or single parents

overseas for Surrogacy, nearly three times the number in 2008 and up from just 33 in 2007.

All of the clients in 2009 went to India except seven who chose Panama. Most were from

the U.S.; the rest came from Europe, the Middle East and Asia, mostly Japan, Vietnam,

Singapore and Taiwan.

No official agency keeps track of the number of would-be parents who travel to India for

Surrogacy. But the proliferation of clinics around the country providing such services gives

some idea of the rising demand for Surrogates: women who bear children on behalf of

other people, often in return for money, a practice that is legal in India.

____________________________________________________

38 Margot Cohen ,“Hiring A Surrogate in India WSJ” 2009, Oct.9, available at http://www.wsj.com/articles /SB10001424 0527 4870425200 45744 59003279407832

Mr. Rupak says that because of growing demand from his clients for eggs from Caucasian

women, he's started to fly donors to India from the former Soviet republic of Georgia,

where he has connections with clinics. The first woman arrived last month. A Planet

Hospital package that includes an Indian egg donor costs $32,500, excluding transportation

and hotel expenses for the intended parent or parents to travel to India. A package with

eggs from a Georgian donor costs an extra $5,000.

Another city of Maharashtra, which is in nascent stage of Surrogacy is Pune. A woman and

Child Specialty Hospital ONP Tulip has launched the city’s first Surrogacy centre in the

year 2013. The hospital that is well known in the field of IVF and high risk obstetrics will

~ 235 ~

offer guidance and medical, legal and administrative support for the entire Surrogacy

process, Dr. Amita Phadnis, Director, ONP Tulip, said.

“We screen the potential Surrogate woman to ensure that she is medically and

psychologically fit to go through the pregnancy. Our selection criteria are strict

and the potential Surrogate woman has to undergo a lot of medical fitness tests,

before her selection is approved. Most important, she should voluntarily make a

decision of Surrogacy”.39

Looking at these stories, it’s very apparent that Surrogacy is increasing at an alarming rate

in Maharashta and especially in Mubai, Pune, Nagpur etc. And therefore for the first time

in India, the Maharashtra Medical Council (MMC) has decided to formulate rules and

regulations on Surrogacy and has formed a committee for the same. The step was taken

after the Mumbai Police Commissioner wrote a complaint letter to the MMC alleging

malpractice on part of city's three leading infertility experts, who are from the Surrogacy

sector.

__________________________________________

39 Kshirsagar A., Pune gets first surrogacy centre 2013, Jan 10 http://www.thehindubusinessline.com/news/pune gets-first-surrogacy-

centre/article4294357.ece

The three Clinics are Bandra's Rotunda Fertility Clinic, Andheri's Corion Fertility

Clinic, and the Surrogacy clinic at the Lilavati Hospital in Bandra. The committee

constituted by MMC comprises Gynaecologist Dr Sanjay Gupte from Pune and Senior

Gynaecologist Dr Bipin Pandit of Mumbai. MMC is a statutory body that has the power

to suspend a Doctor's license if s/he is found guilty of malpractice. Currently, the

Surrogacy treatment is unchecked, unsupervised and not regularized. According to sources,

there are around 70-80 IVF Centre’s in Mumbai and 200 in the state, with the numbers

rising over the past few months. The cost of the treatment runs into lakhs.40

~ 236 ~

The letter, which was written to MMC last month, requested the body to look into the

Doctors' alleged malpractices. The issue was discussed in a meeting of the ethical

committee on Saturday. In the absence of any clear regulations on Surrogacy, committee

members felt the need to introduce the same to keep a watch on it. MMC member Dr

Shivkumar Utture said, "We discussed the letter and how the surrogacy sector is

unregulated. We will investigate the allegations in the letter, but, in the meantime, we have

formed a committee, which will formulate rules and regulations for Surrogacy that will be

applicable for Maharashtra."41

Keeping a watch on Surrogacy has been a long-pending demand of health activists. There

have been cases wherein the Surrogate mother was exploited by doctors for money. Dr.

Satish Pawar, Director of Health Services in Maharashtra, said, "There are many

things in Surrogacy that need to be looked into. Exploitation of the Surrogate Mother is the

biggest problem. The state too has its own committee looking into the Surrogacy Rules and

regulations."42

______________________________________

40 Santosh Andhale and Somita Pal, Maharashtra Medical Council forms panel to regularise surrogacy, 2014, 6th April http://www. dnaindia.com/india/report-maharashtra-medical-council-forms-panel-to-regularise-surrogacy-1975602

41 Id.

42 Id.

The Indian Council of Medical Research, drafted the Assisted Reproductive Technology

(Regulation) Bill and Rules in 2008, then revised draft in 2010 and now in 2013, but it's

unfortunate that the proposed law is still pending in Parliament. Presently, the Surrogacy

sector in India is said to be around Rs 900 Crore, which, according to industry experts, is

growing at 20% every year. Each birth costs as much as Rs 12 lakh, out of which the

Surrogate Mother gets only Rs 3.5-4 lakh, apart from Rs 5,000 a month for her food and

nutrition supplements.

~ 237 ~

Indian Medical Association Secretary Dr Jayesh Lele said, "The state health department

had appointed an eight-member expert committee to formulate rules and regulation on IVF

treatment six months ago. After our meeting, we filed a report and submitted it to the

Government. For such kind of treatment, there need to be rules in place."

In nutshell, whatever be the ethics of promoting Commercial Surrogacy, there is no doubt

that its turnover is likely to grow as same-sex marriage is increasingly becoming legal in

the West. It is, therefore, high time that a suitable law is enacted in this regard. A bill,

introduced in the Maharashtra legislature about two years ago to deal with issues related to

Surrogacy, is yet to be passed. Maharashtra has stolen a march over other states in

exploiting the potential of the New Reproductive Technique, though states like Kerala are

not far behind. At the Centre, a draft Assisted Reproductive Techniques Bill, framed in

2008, revised in 2010 and then in 2013 has been pending in Parliament. The Centre should

come up with a model law to deal with all Surrogacy related issues.

Following is the list of few IVF Clinics43 working with the

“Motto - Making happy families out of couples” and claims that treating

infertility is not an occupation for us, but it is our passion and we do it with

compassion. _____________________________________________________ 43 See http://www.hiranandanihospital.org/content/ivf-clinic.html, http://ivfinindia.in/, http://www.startlocal.in/fitness/infertilityivf services/maharashtra/ http://www.icmr.nic.in/icmrnews/art/List%20of%20Enrolled%20ART%20Clinis-5%203%202013.pdf

IVF CLINICS IN MAHARASHTRA

Rotunda Clinic: Mumbai

91-022-26405000

672, Kalpak-Gulistan, Perry Cross Road, Near Otters Club, Bandra West,

Mumbai, Maharashtra, 400050

Rotunda Fertility Clinic and Keyhole Surgery Centre

91-022-26390044

~ 238 ~

Shastri Nagar, X-13, Garden View, 7-10, Near Lokhandwala Circle, Andheri West,

Mumbai, Maharashtra, 400050

Rotunda-The Center for Human Reproduction 91 22 2655 2000

Website : http://www.iwannagetpregnant.com

Mail: iwannagetpregnant9@gmail.com

Corian Fertility Clinic,

91-22-26395588/5599

2nd Floor, Trans Avenue, Lokhandwala Road,

Near Versova Telephone Exchange,

Andheri (West), Mubai – 400053, India

Kamala Polyclinic & Nursing Home Dr. Jatin Pankaj Shah

66-C, Motiwala Building, 1st Floor, Gowalia Tank, Mumbai-400026, Maharashtra.

Email: drjatin2000@yahoo.com ; kpclinic2011@gmail.com

Website: www.drjatinshah.com

Surrogate India 91-098-20281854

Mumbai, Maharashtra, 400014

Dept. of Assisted Reproduction & Genetics Dr. Firuza Rajesh Parikh

Jaslok Hospital & Research Centre, 15 Dr. G. Deshmukh Marg, Mumbai-400026, Maharashtra.

Email: frparikh@gmail.com ; ivfjaslok@gmail.com

Website: www.ivfclinicindia.com

Gynaecworld Assisted Fertility Unit Dr. Duru Shah

Gynaecworld, 1st Floor, Kwality House, Above Chinese Room, Kemp’s Corner,

Mumbai- 400026, Maharashtra.

Email: durushah@gmail.com

Website: www.gynaecworld.com ; www.ivfclinicindia.in

~ 239 ~

Malpani Infertility Clinic Pvt. Ltd. Dr Aniruddha Malpani

Jamuna Sagar, Shahid Bhagat Singh Road, Colaba, Mumbai-400005, Maharashtra.

Email: info@drmalpani.com

Website: www.drmalpani.com

Narvekar Infertility and Endoscopy Clinic Dr. Ajanta Narvekar

Patel Chambers, 2nd Floor, Opp. Opera House Theatre, Next to French Bridge,

Mumbai- 400026, Maharashtra.

Email: drnitnar@hotmail.com ; nmn@drnarvekar.com

Website: www.drnarvekar.com

Nirmiti Fertility & IVF Dr. S. Krishnakumar

1st Floor, Parasmani Building, Near Naupada Police Station, M.G. Road,

Shahu Market Thane(W), Mumbai-400602, Maharashtra.

Email: nirmitifertility@gmail.com

Website: www.nirmitifertility.com

Shreyas Infertility & IVF Centre Dr. Shreyas Padgaonkar

Aparna Hospital, J. Nehru Road, Mumbai-400080, Maharashtra.

Email: shreyas@siivf.com ; shreyaspadgaonkar@gmail.com

Shruti Nursing Home, Centre for Human Reproduction Dr. Hitesh Parikh

19-A, Pali Road, Opp. HSBC Bank, Bandra (West), Mumbai–400050, Maharashtra.

Email: hiteshparikh57@gmail.com

Website: www.latestinivf.com

Southern Cross Fertility Centre Dr. Faram Erach lrani

United Western Apartments, Ground Floor, Veer Savarkar Marg, Prabhadevi,

Mumbai- 400025, Maharashtra.

Email: drfaram@gmail.com

Website: www.southerncrossfertility.com

Tomar IVF Centre

~ 240 ~

Dr. Sushma Gajendra Tomar

Tomar Nursing Home, Prabhu Appt., Opp. Union Bank of India, Ulhasnagar-421001, Maharashtra.

Email: sushmatomar59@yahoo.com

Website: www.tomarnursinghome.com

Deogiri Nursing Home-Endoscopy & Test Tube Baby Center Dr. Pandit Palaskar

1, Bhanudasnagar, Jawahar Colony Road, Behind Akashwani & Big Bazaar,

Aurangabad- 431005, Maharashtra.

Email: dr@panditpalaskar.com

Website: www.panditpalaskar.com

Patankar Fertility Solutions Pvt. Ltd. Dr. Amit Patankar

Patankar Fertility Solutions Pvt. Ltd., 500/B/1, Parvati, Opp. Sarasbaug, Pune-411009, Maharashtra.

Email: genesispune@gmail.com ; info@patankarhospital.com

Website: www.patankarhospital.com

Genesis Fertility, IVF & ICSI Centre, Pune Dr. Leena Patankar

Genesis, Fertility IVF & ICSI Centre, 986/A/1, Shukrawarpeth, Opp. Saras Baug,

Pune, 411002, Maharashtra.

Email: genesispune@gmail.com ; info@patankarhospital.com

Website: www.patankarhospital.com

Bloom Fertility Centre Lilavati Hospital 91-098-23561231

Bandra (w.) Mumbai, Maharashtra, India 400050

Merck Specialities Pvt Ltd 91-022-66609000

Shiv Sagar Estate A, Dr Annie Besant Road, Worli, Mumbai, Maharashtra, 400018

Morpheus IVF 91-022-42030900

606, 6th Floor, Dev Plaza, Opp Shoppers Stop, Andheri W, Mumbai, Maharashtra, 400058

Shri Chaitanya Fertility Clinic 91-025-12860742

Royal Status, Sir Balchandra Marg, Behind Mid Town Pritam Hotel, Kohinoor Road,

Lokmanya Tilak Colony, Dadar East, Mumbai, Maharashtra, 400014

~ 241 ~

Shivani Scientific Industries Pvt Ltd

91-022-28961768

26A, Raju Industrial Estate, Penkar Pada Road, Nr Dahisar Checknaka, Mira, Mumbai, Maharashtra,

Dr Nandita Palshetkar Clinic

91-093-23312315

Mumbai, Maharashtra, 400050

Ayyub Khan Clinic 91-094-22522603

66, Ganesh, Peth, Firoz, Chambers, Floor 4, Pune, Maharashtra, 411002

Dr A K Pawar Institute

91-025-32596797

Charuhas, Nr Gaikwad Classes, Nashik, Maharashtra, 422001

Wardhman Hospital Malegoan Road, Nandgoan, Maharashtra

Dr L H Hiranandani Hospital 91 22 25763333 / 25763300. Fax : +91 22 2576 3344 / 3311

Hill Side Avenue, Hiranandani Gardens, Powai, Mumbai (400 076)

Email : wecare@hiranandanihospital.org

http://www.startlocal.in/fitness/infertilityivfservices/maharashtra/

Ankur Fertility Centre

A, 01, First Floor, Imperial Mahal, Above HDFC Bank, Khodadad Circle, Dadar T.T., Mumbai 400 014.

RAJASTHAN Surrogacy is growing as an industry in the state as many childless couples from abroad are

coming Rajasthan with hopes of getting a child through Surrogate Mother. Women from

~ 242 ~

different walks of life have played the role of Surrogate Mother for mostly childless Indian

couples living in Gulf, South-East, UK and other countries.

Rajasthan is yet another Indian state, in the booming business of Outsourcing Motherhood.

Though, if we compare it to Gujarat and Maharashtra it is far behind in Surrogacy. But the

growth in ART Clinics in Rajasthan reveals that it is on the way to become another

paradise of infertile couples soon.

Medical director of a Jaipur-based Fertility Centre, Kailash Garg said: "Our clients

are from various countries. There are some medical disorders which can prevent a woman

from conceiving a baby.” Unlike Mumbai and Gujarat in Rajasthan the stigma attached to

Surrogacy is disastrous. Neither party wishes to disclose their Identity. The women acting

as Surrogate do not reveal their identity as there are apprehensions that sometimes they

may be expelled from their caste, if others come to know that she is a Surrogate Mother.

The Doctors and the Clients keep the identity of the woman secret. Says Dr. Garg, "The

clients select the woman for Surrogacy from a decent family background. The woman

should be healthy. She should not have health related problems like HIV, Hepatitis or any

mental illness. We are doing it following all the legal guidelines of the Indian Council of

Medical Research. We do not arrange the Surrogate Mother. It is the couple's job. Our job

is clinical only." 44

Moreover, a private fertility centre in Udaipur is also providing facilities for Surrogacy.

Centre's Doctor Kshitiz Murdia said, "Our clients are from India as well as from abroad.

In a month, we give clinical services to at least five couples." Surrogacy industry is

growing in Rajasthan but in very secretive manner. As the populace of Rajasthan is

Conservative so the parties involved in it maintains the confidentiality. In Abu Road,

which is close to the Gujarat border, a woman working as a housemaid earlier is now

completely into the business. This is fourth time she is conceiving a baby as a Surrogate

~ 243 ~

Mother. A Member of Society for All Round Development (SARD), Sirohi Brijmohan

Sharma said: "The woman is now conceiving the baby of a couple living abroad." The

doctors follow the common In-Vitro Fertilization (IVF), a process for using sperm to

fertilize egg outside the body.

In last few years it is being observed that there is mushroom growth of ART Clinics in

Rajasthan. Out of them few are enrolled under National Registry of ART Clinics and

Banks in India, Indian Council of Medical Research, New Delhi45 and rest are running

on their sweet will. The industry is totally unchecked and unregulated. Following is the list

of few IVF Clinics running in Rajasthan.46

____________________________________________ 44 Syed Intishab Ali, “Spurt in women opting to become surrogate mothers” 2013,Apr 22, available at http://timesofindia.indiatimes .com/city/jaipur/Spurt-in-women-opting-to-become-surrogate-mothers/articleshow/19669561.cms 45 For detail list of ART Clinics enrolled under National Registry of ART clinics and Banks in India Visit http://www.icmr.nic.in/icmrnews/art/List%20of%20Enrolled%20ART%20Clinis-5%203%202013.pdf

46 See http://www.icmr.nic.in/icmrnews/art/List%20of%20Enrolled%20AR%20Clinis-5%203%202013.pdf , http://www.justdial .com/ Kota-rajasthan/Infertility-Clinics/ct-10265454, http://www.whatclinic.com/fertility/india/rajasthan

IVF CLINICS IN RAJASTHAN

Indira Infertility Clinic and Research Centre 9, Govindpura Colony , Opp. M.B. College Ground, Near Subhash Nagar, Udaipur, 31

Neelkanth Fertility and woman care Hospital

91-294-6530105

10-11, Doctors Lane, Near RSEB Office,

Behind Celebration Mall, Bhuwana, Udaipur.313001 (Raj.) INDIA

New Enquiries: +91-96363-28777, +91-91662-58999

Existing/Old Patients: +91-97846-00614

neelkanthfertility@gmail.com

International Fertility & Healthcare Center Dr. Vibha Kailash Garg

International Fertility and Healthcare Center, Dr. Garg Tower, *Near Reserve Bank of India,

456, Swai Ram Singh Road, Jaipur-302004, Rajasthan.

~ 244 ~

Email: vibha_garg@hotmail.com

Website: www.fertilitytreatmentindia.com

Shivani Fertility & IVF Centre Dr. Neelam Bapna

Saket Hospital, Sector-10, Meera Marg, Mansarovar, Jaipur-302020, Rajasthan.

Email: drnbapna@yahoo.com

Website: www.jaipurivf.com

Aanchal Fertility & Mother Care Hospital Dr. C.P. Dadhich

Near Pareek College Turn, Behind Zanana Hospital, Jhotwara Road, Chandpole Bazar,

Jaipur-302016, Rajasthan.

Email: sushila.kartavya@gmail.com ; aanchal.sushila@gmail.com

cpdadhich_dr@yahoo.com ; care@aanchalcare.com

Website: www.aanchalcare.com

Bhandari Hospital and Research Centre Dr. Rekha Bhandari

138-A, Vasundhra Colony, Gopalpura Bypass, Tonk Road, Jaipur-302018, Rajasthan.

Email: contact@bhandarihospital.net

Website: www.bhandarihospital.net

Agrawal Neuro Psychiatry Centre

(91)-744-2431217, (91)-9829035071 Main Road, Jawahar Nagar, Kota, Rajasthan

Laser Urology Clinic Dr. Rajesh Jain

(91)-9829878123, 9829279123

Sheela chaudhary road, Talwandi, Kota, Rajasthan

Vivan Hospital For Sexual Health (91)-141-4653324

Queens Road, Vaishali Nagar, Jaipur

~ 245 ~

Sukh Sagar Hospital & Health Centre

(91)-9928413132, 9314501515

No-1, Vishwakarma Industrial Area, Jaipur

Pribbgom Test Tube Baby Centre and Infertility Hospital (91)-9414017364, 7597588800

Scheme No. 1, Alwar Ho, Alwar

Dr Anish Gupta

(91)-744-2364737, (91)-9351656848

Kota-8 , Kota , Rajasthan

Swastik Clinic & Infertility Clinic (91)-9667320198

Main Road, Dcm Road, Kota, Rajasthan

Baheti Hospital & Centre for Reproductive Healthcare Dr. Vinod Kumar Baheti

14, Usha Colony, Malviya Nagar Main Road, Jaipur-302017, Rajasthan.

Email: bahetihospital@gmail.com

Website: www.baheti-ivf.com

Vasundhara Hospital & Fertility Research Centre Dr. Sanjay Makwana

11/11, Nandanwan, Chopasni, Housing Board, Jodhpur-342001, Rajasthan.

Email: vasundharafertility@gmail.com ;

vasundharafertility@yahoo.com

Website: www.vasundharafertility.com

Shri Nidaan Hospital & Hope Fertility Centre Dr. Deepak Chauhan

27, Vidhyut Nagar-A, Ajmer Road, Jaipur-302021, Rajasthan.

Email: hospital_shrinidaan@yahoo.in ; chauhanritu14@yahoo.in

Website: www.nidaanhopefertility.com

~ 246 ~

MADHYA PRADESH

Madhya Pradesh is witnessing a rise in Surrogacy as childless couples from India and

abroad is thronging the state in search of women who are ready to rent their wombs for a

price. The trend has consequently led to the increase in the number of women who are

willing to become Surrogate Mothers to fulfill their financial needs. "Surrogacy is thriving

in Madhya Pradesh. People are now economically and mentally strong and willing to

sidestep traditional beliefs to have children through this method," Infertility Expert Dr

Dinesh Jain told.47

___________________________________________________________

47 Surrogacy on rise in Madhya Pradesh: expert, THE INDIAN EXPRESS, 2010, September 12, available on http://timesofindia.indiatimes.com/india /Surrogacy-on-rise-in-Madhya-Pradesh-expert/articleshow/6540915.cms

Smaller cities in India, such as Bhopal and Indore in Madhya Pradesh, are frequented by

childless couples from other parts of India and even abroad. Unable to bear children for

various reasons, such couples travel to these cities with hope. Bhopal and Indore have

certainly gained popularity as a result of an increasing number of women agreeing to

Surrogacy, carrying another couple's embryo to full term, the many specialized Assisted

Reproductive Technology (ART) clinics, and the comparatively affordable treatment.

Surrogacy has been a common phenomenon in urban India for the past few years. But most

of the prospective mothers would earlier solicit clients only through families, relatives and

Indian agencies. But in Indore the trend has become global. Indore, Madhya Pradesh’s

Commercial Centre, has become a hub for Surrogacy as childless couples, including Non

Resident Indians (NRIs), from all over the world are flocking here, health officials have

said.48 According to them, In-Vitro Fertilization (IVF) centre’s in the state charge Rs 4

lakh or more from a needy couple for Surrogacy.

The primary reason behind the flourishing Surrogacy industry in Indore is Indore’s

emergence as a premier destination in the country for infertility treatment.

~ 247 ~

[

“Indore is among the leading centre’s of such treatment in India. The first

clinic in the city was opened way back in 1976, when even the procedure

was alien to most of the practitioners,”

Dr Dhiraj Gada, President of All India Association of Infertility Doctors.

“The early start gave a boost to the treatment in the city and it grew with the increasing

number of experts and facilities”, said Dr Asha Baxi, who is running Disha Fertility

Centre in the city since year 1998.

_________________________________________ 48 Id.

Not only the early start but the availability of a wide range of facilities coupled with cheap

rates has added to the number of patients visiting the city. Patients from over the country

and even abroad are visiting the city to avail the treatments. “I treat around 8-10 non

residential Indians every year,” added Bakxi.49

Undoubtedly, Indore in Madhya Pradesh is emerging as a centre of Surrogacy on the

global network. Another very big reason of growth of Surrogacy in Indore is Internet.

Surrogacy in Indore has gone global with the Internet. The internet has seen a sudden spurt

of advertisements offering wombs for hire in Indore. Not only are Surrogate Mothers

placing ads on their own on the net, the web is full also of sites that promise to help

childless couples rent a womb in Indore.

For instance, a website hosted out of India, “surrogacyfinder.com”,offers the services of

city women Anjali, 24, Shashakti, 28, Sarika, 28, and Pratibha, 37, as Surrogate mothers

to couples all across the world.50 Individual ads are posted mainly on websites that accept

free ads. Women who want to let out their services leave their name, age and contact

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details on these sites for couples. In all the cases, rates are negotiated only after a personal

meeting or through a trusted intermediary.

Surrogacy Cases are increasing at an alarming rate in Indore and Bhopal. A Bhopal

residents Rajesh Shrivastava, 41, and his wife, Usha, 37, who were unable to conceive

after 12 years of marriage, they decided to go in for ART, this includes techniques such as

In-Vitro Fertilization and Surrogacy. The couple visited the ART centre run by Dr Dinesh

and Dr Shefali Jain in Indore.

____________________________________________

49 DNA , Indore surrogacy ads impregnate world wide web, 2011, Aug 29 http://daily.bhaskar.com/news/MP-IND-indore-surrogacy-ads-impregnate-world-wide-web-2386982.html 50 Id.

"Usha had suffered six miscarriages in 12 years. Initially, the idea of a Surrogate did not

appeal to them. But they agreed when one of their relatives came forward," reveals Dr

Shefali Jain.51 This was two years ago. Now, Rajesh and Usha are proud parents of twin

daughters. The treatment cost the couple just Rs 150,000 (US$1=Rs 39.90). In Indore, one

of the Intended parents on the condition of not revealing their name disclosed that they

gave an ad in the newspaper for the requirement of a Surrogate Mother. Indore which has a

population of 30, 00,000, many women responded to the advertisement seeking Surrogate

Mothers, placed in a leading Hindi daily. Within 24 hours of the advertisement having

appeared, a dozen women had evinced an interest. Surprisingly, none enquired anything

about the couple. Money was the overriding concern.

Generally, Women who are willing to undergo the procedure come from lower middle

class backgrounds, are married, and are in need of money. So much so that, often, childless

couples negotiate a better price as a result of the competition. I personally visited the Clinic

of Shefali Jain in Indore. I was stun seeing the negotiations between the Surrogate and the

Intended parents. Shweta Khanna, 35, from Indore was willing to be a Surrogate mother.

Initially, she asked for Rs 100,000. However, when another woman offered to do the same

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for Rs 75,000, Shweta had to settle for Rs 50,000. "I have been a Surrogate Mother before.

This time I'll have no problem... my husband is also agreeable," she says.52 Most women

insist on anonymity for fear of social stigma.

There are more than a dozen clinics having renowned experts offering their services in

Indore. President of All India Association of Infertility Doctors, Dr Dhiraj Gada who

is also credited with having the first infertility clinic in the city in the year 1976 said, “The

affable nature of the people is also making the city a hub of infertility treatment.” Since a

lot of people come to the city for treatment, there is a huge demand for Surrogate Mothers.

________________________________________________________________ 51 Shuriah Niazi , Surrogacy Boom, 2007, Oct 14 , available at www.boloji.com/index.cfm?md=Content&sd=Articles&ArticleID=3056

52 Id.

DNA responded to an ad by a woman called Aarti Patel, 24, whose local contact was a

resident of Rajwada, Indore.53 The contact said his ‘sister-in-law’ is currently in Gujarat.

But she would come to Indore if the couple wanted to negotiate a deal with her. Patel said

his relative, mother of a child, is in dire need of money. When asked about the charges he

did not comment. But amidst all the doubts and societal taboos, the number of childless

couples wishing to have a child through this technique is on the rise. It is estimated that in

Indore, which has 11 very renowned and popular ART Centre’s, around 200 childless

couples have been treated over a period of three years.

In Madhya Pradesh, apart from Indore few other cities are even earning laurels in the field

of Surrogacy including Bhopal and Jabalpur. Apart from the domestic rush, a large

number of couples from abroad also travel to Bhopal and Jabalpur to fulfill their desire for

a child. Several American, Russian and British women are duly registered with the Bhopal

Test Tube Baby Centre for the procedure. Often, couples have to wait for as long as eight

months to a year for their turn.

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Another reason is the financial cost of Surrogacy which is 5-6 times lower in India than

European countries. Besides, it is difficult to get a Surrogate Mother in those countries

following stringent laws in vogue there. Hence it is very clear from the above discussion

that surrogacy is growing in Madhya Pradesh for varied reasons at an augmenting rate and

especially in Indore and Bhopal. Following is the list of few very popular IVF Clinics in

Madhya Pradesh.55

IVF CLINICS IN MADHYA PRADESH

BASER GYNECOLOGY and IVF Centre

9/2, Manorama Gunj, Street No.5 Indore 452001

Their reasons for coming to India are varied. For some, the treatment is far too expensive

in their own country; for others, their National laws do not permit Surrogacy. Recently, a

37-year-old Russian came to Bhopal as the expense for Surrogacy is prohibitive in her

country - between Rs 15, 00,000 and 20, 00,000 - as compared to the Rs 200,000 cost in

Bhopal.

Dr Randhir Singh, Director, Bhopal Test Tube Baby Centre, elaborates, "Women

source information about the availability of Surrogate Mothers in Bhopal over the Internet

and then contact us. In foreign countries, Surrogate Mothers are not easy to find.

Therefore, they are interested in India.”54

___________________________________________

53 Supra note, 49

54 Supra note 51

According to Senior Advocate Kirti Gupta, "At present, it is not difficult to have a baby

through Surrogacy in India because there is no law to control or regulate it. The technique

is cheap, when compared to other countries, and Surrogate Mothers here charge

comparatively less for the services."

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IDEAL FERTILITY : ICSI / IVF & Genetic Center Dr D 'Pankar Banerji ( MS, OBGY)

Consulting Gynecologist and Fertility Specialist

IDEAL FERTILITY : IVF and Genetic Center

1st Floor, Deshbandhu Complex, Naudra Bridge,

Jabalpur, MP INDIA – 482001

Telephone :- + 91- 761 -2627711, 4046361

Mobile :- 91 - 0 – 9826166952

Mail :- dpankar@idealfertility.com

_________________________________________________

55 List of Enrolled Assisted Reproductive Technology (ART) Clinics under National Registry of ART Clinics and Banks in India, Indian Council of Medical Research, See http://www.icmr.nic.in/icmrnews/art/List%20of%20Enrolled%20ART%20Clinis-5%203%202013.pdfhttp://www.morpheusivf.com/fertility-centers/indore-fertility-center

Asian Institute of Infertility Management & Dr. Shefali Jain Test Tube Baby Centre

Dr. Shefali D Jain

10/E, HIG Main Raod, Near Christian Eminent School, LIG Circle, A. B. Road,

Indore-452001, Madhya Pradesh.

Email: drshefalijain@aiimivfindore.com ; drsdjain@yahoo.com

Website: www.aiimivfindore.com

Morpheus Sridhar International IVF Center Dr. Jayashree Sridhar

48, Annapurna Road, Near Annapurna Temple, Indore -452001

O7314094149

Disha Fertility & Surgical Centre Dr. Asha A. Baxi

E-30, Saket Nagar (Extension), Indore-452001, Madhya Pradesh.

Email: aabaxi@gmail.com

Website: www.dishafertility.com

Bhopal Test-Tube-Baby Centre & Aman Hospital Dr. P. C. Jindal

E-1/13-A Arera Colony, Bhopal-462016, Madhya Pradesh.

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Email: bttbcentre@gmail.com

Website: www.ivfgo.com

Dr. D'Pankar Banerji's Fertility Clinic 1st Floor,Deshbandhu complex, 482001

Naudra Bridge, Jabalpur, Madhya Pradesh, India

Tel. 0761 2627711

Dr. Ashwini Trikha,Dr. Mala Tiwari Jaganath Chambers, Padav, Gwalior

Madhya Pradesh, India 474002

917512376655

Indore Fertility Clinic First Floor C.H.L Hospitals,

L.I.G Square,Indore – 452008, M.P, India

Call us at: 0731-6621357-62

Write to us at: contact@indoreinfertilityclinic.com

Akash Hospital, Indore Surrogacy centre, Plastic Surgeons

Bicholi Mardana Main Road, Opposite Agrawal Public School,

Indore - 452001

Akash Hospital, Pragati Vihar Surrogacy Centre, Gynecologists & Obstetricians

Main Raod, Bicholi Road, Pragati Vihar,

Indore - 452014

In nutshell, Surrogacy in India is spreading like a fire in a Jungle and especially in Gujarat,

Maharashtra, Rajasthan and Madhya Pradesh. The ART industry, of which Surrogacy is a

part, is estimated to run in several thousand crores in the country. Even as an increasing

number of childless couples from overseas come to India, legal experts express their

reservations. Many foresee hurdles after the child is born and caution that Surrogacy

should be carefully considered.

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In India Surrogacy is ungoverned by any laws. In the year 2009, Law Commission Report

has stressed the need to regulate ART clinics. Advocate Piyush Jain, who handles

Surrogacy-related cases, said a proper law should be in put in place to deal with issues

arising out of this Assisted Reproductive Technology (ART). Though, Surrogacy is

adopted by many reputed Institutions as a practice and the field is gaining momentum both

economically and qualitatively in India but still it is unregulated. In this chapter the

researcher has thrown light on the Social Scenario of Surrogacy in India. Now let’s us

study the Legal Scenario of Surrogacy in India and the world in the next chapter.

CHAPTER V

LEGAL STAND OF SURROGACY IN INDIA & THE WORLD