THEBIGSTORYthink!| 13SUNDAY HINDUSTAN T IMES, NEW DELHI

MARCH 13 , 201 1

Namita Kohli■ namita.kohli@hindustantimes.com

Even as the Draft AssistedReproductive TechnologyBill andRules, 2010, is beingreviewedby the lawministryfor a fortnight — it’s likelyto be introduced in the

Parliament’sMonsoonsession—India’sacknowledged ‘booming market’ for‘cheap’ reproductive labour and IVFservices is under scrutiny. For manyparents, however, going onto the sur-rogacy ‘market’, is the only recourse,they say.And India,where commercialsurrogacy is allowed, is thedestination.Thirty-somethingAmitMehta (name

changed) insists on being just a voiceon the phone. “I am in India,” is all heis willing to reveal. Amit has his rea-sons: twoyearsback, heandwifeSunitachose an agency in Los Angeles to‘commission’ a surrogacy for around28,000 dollars (R 14 lakh), a procedurethat would have cost less than half inIndia. “We were at a crucial stage inour careers and my wife couldn’t taketime out for pregnancy,” says AmitMehta. So we decided to outsource it.Wedidn’twant anyone toknowso rout-ed it through US.”Mehtarouted it throughLosAngeles-

based Rudy Rupak of PlanetHospital,oneof the severalmedical tourismagen-cies that have sprungup in theUS thatliaise between American parents andIndian clinics/surrogates.

PACKAGEDDELIVERYAs the Bill shuttles between min-

istries, in the industry of reproductiveoutsourcing (estimated tobeworthover2000 crores), wombs cannowbehiredfor the ‘best’priceandchildrenaredeliv-ered through ‘low cost’ and ‘easilyaffordable’ packages. Now, the latest

pitch is to offer customised and afford-able packages.This ‘boom’ is supported by a set of

guidelines (designed by the IndianCouncil of Medical Research) that isone of themost lax regulatorymecha-nisms for those offering and commis-sioning surrogacy. (In contrast, mostEuropean countries, and Hong Kongand Japan inAsia either explicitly bancommercial surrogacy, or have strictrulesgoverning it.)Add to that thepricefactor: surrogacy in the US could costupto 65 lakh as opposed to the 500-oddIndian clinics where costs could workout within 4 lakh — and India winshands down.Andwherethere’samarket, thereare

pricedifferentials:between8and22lakh,the ‘commissioning’ parents are spoiltfor choice. At PlanetHospital, for exam-ple, a couple can choose between ‘eco-nomical’packagesstarting fromaround15 lakh,andofferingfourtransplantswithupto four surrogates. The packageincludes ‘recruiting’ the surrogate(s) inIndia,uptofourembryotransfers,check-ing the surrogate’s background, herallowances and legal work.For international couples, eggdonors

can be sourced from South Africa,Russia, the UK, US and of course, therising number of egg banks in India,where skin colour, education, back-ground are—almost— for the asking.“Multi-racial babies are consideredmore attractive,” reveals Dr ShivaniSachdev Gaur, fertility specialist atPhoenixhospital,GreaterKailash,Delhi.There’s also another special service:

at Rudy Rupak’s, you can opt for sexselection, a practice that is legal in theUS, but not in India.“The procedure is done in Panama,

where it is legal. Two-three couplesfrom India have already opted for it,”says Rupak.

CHOICE, BUTFORWHOM?For those seeking ‘quality’, India

offers a lot of options. Jagatjeet Singh,owner of Wyzax Medical Tourism,Janakpuri, says he has an established“professional network” of surrogateagents across North India: some ofwhomboastupto “300potentials” readyfor surrogacy. Indian surrogates arepreferred because of “good looks, edu-cation and good ethics”, including no-smoking and drinking habits, he says.At the bottomof the ‘package’ pyra-

mid is someone like Radhika Kumar(name changed), 35, a housewife fromOrissa and now a surrogate for anAmerican couple. This is her secondsurrogacy. And that’s where the storystarts to get worrying. While Rupakinsistshewill notallowRadhika, amoth-er of two, to become a surrogate again,there’s no telling that she won’t betempted, especially in an unregulatedmarket where everyone decides therules of the game. Says Singh: “It’s adirty business. I paymy agent R 4 lakhper surrogate, but I am sure they endup paying only about R 1-2 lakh.”The ICMR guidelines allow upto 3

embryos transfers per surrogate, butthere are packages that promise upto4-5 embryo transfers leading to thedan-ger of multiple pregnancies and foetalreductions.Women’s groupsargue that it’s unfair

that the surrogate is required tounder-play her bond with the child at everystage: she is not allowed to evenbreast-feed the child. Doctors such asJanakpuri-based Dr Manika Khanna,an infertility specialist, point out to“exploitation” at the hands of the sur-rogate’s husband, who often bargainfor a higher compensation, or threat-en to terminate thepregnancymidway.But for Kumar, it’s worked out well.

At least, for now. “Back home, I lied toeveryone that I am away working as ababy sitter inMumbai for a fewmonths.But it’s all for my family’s good only.”

For Diksha Gurung (left), and GangaBhujal, a lot rests on getting pregnant.“With my first surrogacy (fee), I couldgetmyhusband’skidneyoperationdone,admit my son in an English mediumschool, and buy a small flat,” Diksha,the 27-year-old housewife and motherof two, who moved from Nepal toAhmedabad with her husband about adecade ago, rattles off.AtDrNayanaPatel’sclinic inGujarat’s

Anand district— this is the sisters’ sec-ondsurrogacysince2008—gettingpreg-nant is amoment of great relief.Diksha,whohadalreadydonatedhereggssix timesbeforeshebecameasurrogate,was lucky toget pregnant in the first try.The“Japanesepartywaale (intendedpar-ents)” chose her since she had donatedeggs for them earlier, she says.Diksha’s egg donations got her about

R 3.15 lakh.Her sisterGanga, 23, left herjob in Kuwait after she was abused ather employers’, but couldn’t return toher family inNepal until shehadenoughmoney. For both sisters then, a packagein lakhs, obviously, meant a lot. It did-n’t matter that the neighbours initiallygossiped that surrogacy work madethem “prostitutes”.But it’s hard to give away the chil-

dren, they admit. Gangahasn’t seenherown child for five years now. With thesurrogacy (fee), she will now be able tomeet her own daughter.

WhenYohannaMJohnson’s sister-in-law suggested she become a surro-gate, she thought that she could final-ly buy her own house in Gujarat’sAnand district.“Bus (Ok), this is the last time,” she

says, after asking to finish the inter-viewearly since the “twins inside”weremaking it tough for her.Her husband, who works as a

welder, andearns R 2,000-3,000 is sup-porting her through this, and even“gets her food” everyday at the sur-rogate house of Dr Nayana Patel.“Everytime he comes to see me,”

she says wistfully, “this is all he says:‘Come home soon.’”

wombsonhire

In 2008, Nainaben, a former nurse,had read about surrogacy in a localpaper, and thought it might be ananswer toher financialwoes.The firsttime it was for the children’s educa-tion.After the first surrogacy, she lefther job as a nurse. Her husband runsa local marriage bureau. Together,theywouldmakearound R 10,000, andwith two kids it was certainly hard topull it off.“I was a nurse, so I knew how it

worked,” she says, explaininghowsheconvinced her husband and kids. Sowhen the samecouple approachedherthe second time last year, Nainaben

thought this time she could get somemoney to travel to Israel for a job.“Theywere happywithme last time,”she says. Now, after she deliveredtwins througha ceasarian section twomonths ago, the commissioning par-ents have promised to help out withher flight tickets as well.“Of course, I miss the children I

have given away,” she says. “But youlearn to cope when you have to planthe best for your kids. See, in Israel,I will get R 50,000 everymonth there.Can I ever earn that much here?Never!.”

NNaammiittaa KKoohhllii

MUM The controversial fertility market isgrowing into a full-fledged shopping industryeven as the new surrogacy bill shuttlesbetween the health and the lawministries

Source: FERTILITY CLINICS. COSTSMENTIONED ARE APPROXIMATES

YOHANNA JOHNSON, 23HER PACKAGE:R3.5 lakh forsurrogacy. She will get 25%moreif she delivers twinsMONTHLY EXPENSES:R2,000-3,000 for food,clothes, other expensesGENETIC PARENTS: Undisclosed

NAINABENMACKWAN, 38HER PACKAGE:R3 lakh for firstsurrogacy,R4.5 lakh for secondsurrogacy, includes extra paymentfor the twinsBONUS/GIFT: Promised flightticketsGENETIC PARENTS: American

DIKSHA GURUNG, 27HER PACKAGE:R 3.5 lakhfor surrogacy +R 1.5 lakh forchild care for 2 monthsEGG DONATION (BEFORESURROGACY):R 3.15 lakhBONUS/GIFT: Toshiba laptopGENETIC PARENTS:Japanese

ONTHE

Surrogate charges:R 1,00,000-3,50,000This fee varies across variouscities, IVF clinics and the thirdparty (recruitment agents)involved. To claim this, surro-gates need to be “healthy”,married, have at least onechild and be “mature enough”to understand/handle thesurrogacy .Specific demands can bemade by parents. Forinstance, Israeli couples don’twant Muslim surrogates.Some couples want to ensurethat the women don’t smoke,drink and are “religious-mind-ed”. Clinics can also bechoosy: not all will agree to dosurrogacy for gay couples.

IVF procedure costs:R 66,000 Some IVFpackages include upto 4embryo transfer attempts.So, a surrogate could beimplanted with about 3-4embryos to ensurepregnancy.Egg donor (Indian):R 1,80,000 extraHighly qualified, post gradu-

ate, fertile, fair complexionedegg donors can demand uptoR 50,000.Egg donor(Blonde, blue-eyed): Addanother R 1,80,000 fordonors flown in from the US,UK, RussiaTwins: R 1,35,000 extra forhandling complications,C-section etcHiring a second surrogate:Add another R4 lakh to thepackage.There will be an extra cost ifboth surrogates get pregnantand foetal reductions need tobe done.Surrogate compensation:R 2,000-3,000 for food.This varies across cities.Some surrogates say they geteven lesser thanR 2,000. Some parents sendacross gifts, for the surrogate,clothes for her children,religious texts and songs andalso end up offering any othermonetary help.Other add-ons: Spapackages, Agra tours, airportpick-up, drop

The surrogacy market has been largelyunregulated. There is the Indian Council ofMedical Research (ICMR) guidelines—butthey are not binding.Now, the latest versionof the Bill is being looked at closely. Its plus-es: it includes single parents, reduces theage of surrogates from 45 to 35 years, andmakes it mandatory for foreign couples todeclare that their countries permit surro-gacy.Activists, however, point out loopholes:

■ The major payment (75 %) to be madeonly after delivery.

■ The surrogate can’t donate eggs so theinfertile couplewill needaneggdonor. “Asur-rogatewill nowbesubject toahazardousandexpensive procedure like IVF rather than asimpler one like intra uterine insemination(IUI),” says NB Sarojini of NGO Sama.

■ Insurance:Provides for ‘appropriate’ insur-ance cover for the surrogate. But this kindof insurance and the ‘appropriateness’ for itis not defined.The responsibility of the com-missioningparents post-delivery and follow-up care of the surrogate is also not clear,according to Sama.

■ IVF cycles: There’s no limit to the num-ber of IVF cycles the surrogate will have togo through for one birth.

■ A local guardian to keep a ‘close watch’on the surrogatemay hamper her freedom.

THE SURROGACY SUPERMART

THE PROPOSED BILL

From being a centre of cheapreproductive labour, India is now virtuallya surrogacy supermarket where dealsare available off the shelf and bonusesare thrown in for good measure. Here’swhat it takes to go baby shopping:

SAMPLE SURROGACY PACKAGES

R15,75,000PlanetHospital, Medical Tourism Agency, USA

R13,50,000Wyzax Medical Tourism Agency, New Delhi

R700,000Akanksha Fertility Clinic, Gujarat

■ Surrogates wait in line for inspection atDr Nayanaben Patel’s infertility centre in thedistrict of Anand, Gujarat. Most of the surrogatesare second timers and say they are compelled torent out their womb due to financial difficulties.The ethical debate on surrogacy continues.

VIJAYANAND GUPTA / HT PHOTOS

MOMSMARKET

64 % of my clientsare Indians, of which,

37 % are NRIsDR NAYANA PAT E L ,

Akanksha Fertility Clinic, Gujarat