Banking on the womb

India does not have any law that governs surrogacy. There are only guidelines by the Indian Council of Medical Research, but no law for effective implementation of these guidelines. This gives a chance to unscrupulous elements to do a host of illegal activities

All through the nine months of her pregnancy, 28-year-old Rashmi Singh (name changed) knew that the child was not hers. She had mentally prepared herself to relinquish the child right after birth. But the day of the delivery proved to be the most traumatic. She was not even allowed to have a glimpse of the child’s face she had carried in her womb for nine whole months.

But denying the possible emotional bonding between a surrogate mother and the child is only a small element compared to the numerous ways the surrogates are exploited, say women’s rights activists. Mostly hailing from economically poor and uneducated backgrounds, many of these women are victims of poorly monitored surrogacy clinics, hundreds of which have mushroomed in the capital.

India does not have any law that governs surrogacy. There are only guidelines by the Indian Council of Medical Research (ICMR), which govern surrogacy, but no law for effective implementation of these guidelines. The contractual relation between the parties is determined only by the surrogacy agreement.

The guidelines do not prescribe doctors to be a part of the contract.
According to Dr Ranjana Kumari, director of Centre for Social Research, this factor saves doctors of any legal hassles in case of complications, and hence any responsibility. CSR recently conducted a study on the condition of surrogates in Delhi and Mumbai and found numerous disturbing trends.
Even the contract papers are skewed towards the commissioning parents (the couple who wants a child). “Our study found that surrogate mothers did not have a copy of the written contract of the surrogate arrangements, and were not even aware of the clauses. Some of the women had signed the contracts through thumbprints. How do you expect them to know what the contract holds for them?” says Ranjana.

But surrogate agencies, which usually make all the arrangements from procuring a surrogate to dealing with money and contracts, say all the important clauses are read out to the mother and her husband. “We also provide them the contract papers in Hindi,” says Rameez Khan (name changed on request), an agent of Ana Med Services, a surrogate agency in Delhi. This agency is one of over 10 such set-ups in the capital.

Amidst all this, while top priority is given to the health of the surrogate and the fetus during the nine months of pregnancy, most clinics and hospitals take no responsibility for the surrogates’ post-delivery health.

“Pregnancy does not include only the nine months. Though the before and after period has a lot of impact, it is of no concern to the clinics. I have come across surrogates who have been told to go home the very next day after they have gone through caesarean delivery,” says Surabhi Sharma, a filmmaker who recently directed a film on surrogacy titled Can We See the Baby Bump Please.

“Many surrogates also said that their papers and documents related to surrogacy were withheld by the clinics. So, later when they face any sort of medical problems, they are unable to produce the documents which could show if the problems had any connection with the surrogacy,” she adds.
Reputed IVF clinics in the capital, however, claim that they provide post-delivery healthcare to surrogates. “Surrogate mothers booked with us are provided care till six weeks after the delivery of the child,” says Dr Nalini Mahajan, clinical director of NOVA IVI Fertility Clinic in Delhi.

Though the contract papers forbid any obligation on the part of the commissioning parents to provide any contact between the child and the surrogate mother post-delivery, the nutrition of the child remains a cause of concern. “On one hand, the government promotes breastfeeding and the first milk, and on the other the two are separated right after birth,” says Ranjana.

But IVF experts in the capital say that breastfeeding makes it difficult for surrogates to hand over the child later. “Nowadays, healthy nutrition is provided to infants through formula milk,” says Dr Anachal Agarwal, consultant, IVF and infertility treatment at BLK Super Specialty Hospital.
Mahajan, however, acknowledges that if an infant is not provided mother’s milk, the child does not get some very important immune protection. “But sometimes it is not a possibility due to lack of milk production in the mother or illness. However, these children too grow up healthy,” says Mahajan.

Though most IVF clinics and hospital Deccan Herald visited claimed that the overall cost of surrogacy comes up to anywhere between Rs 8 and Rs 15 lakh, activists claim that the actual figures in most of the clinics in Delhi range between between Rs 30 and Rs 45 lakh for one surrogate child. For twins, the amount charged was even higher.

The surrogates, meanwhile, are paid between Rs 1.5 and Rs 4 lakh in Delhi for renting their wombs in an industry that reportedly generates over $2 billion annually in India. But there are many flaws when it comes to payment to the women.

Firstly, the surrogates are paid in monthly instalments. “In many shelter homes and guesthouses, where a lot of surrogate mothers are housed, we found that the cost towards accommodation, food and clothes were deducted from the amount paid to them. Since they were paid in monthly instalments and money deducted for the facilities provided, the surrogates had lost the count of money they had received and were not sure if they had received the whole amount,” says Dr Manasi Mishra, who headed CSR’s research on surrogacy.

In case there is miscarriage in the fourth month of pregnancy, they are paid only for the three months of pregnancy. “The health condition post-miscarriage and the bleeding that ensues are not considered by the clinics,” says Sharma.

But according to an IVF expert, who did not wish to be named, the contract papers mention that if the child is aborted or if it dies in the womb, then only a part of the actual amount promised will be paid. “This is mutually agreed upon,” the expert says.

Another glaring aspect of surrogacy that the CSR study came across was that, in case the intended parents did not wish to continue with the pregnancy due to fetal abnormalities or due to other reasons, the baby was aborted, often without consulting the surrogate mother.

“We also came across cases in which two to three surrogate mothers had been impregnated for the same commissioning parents without their knowledge to ensure a high success rate,” says Ranjana. When all these mothers became pregnant, the healthiest pregnancy was allowed to continue while the rest would be terminated by administering abortion pills to the mothers without their knowledge.

Ranjana also claims that during the course of their research, they came across pregnant surrogates who knew the gender of the child that was to be born, thus suggesting that the sex of the child was being determined at some clinics. But the hospitals and clinics that agreed to interact with Deccan Herald on this subject vehemently denied that this practice was followed at their clinics or even at other places. They pointed out that a balanced gender ratio of children born through surrogacy at their hospitals indicates that this illegal practice is not followed.

However, many clinics in the capital refused to provide any statistics on the gender of surrogate children, and some even refused to interact on the subject of surrogacy. The fact that surrogacy is in the news for wrong reasons of late was cited by them as a reason.

While many hospitals that perform surrogacy along with other infertility treatments say pregnant mothers are asked to stay at their own homes, clinics that specialise in surrogacy have special shelter homes, guesthouses and even hotels where many of the surrogate mothers are housed during the whole term of their pregnancies.

Primarily, these residential facilities are arranged to provide hygienic living conditions, nutritious food, to monitor their health and to prevent them from physical relationships with their husbands to thwart any chances of them contacting HIV/AIDS.

But activists claim that they are not allowed to go to their homes in between, come what may. “It is a bit like a prison. Family members are allowed to meet them sometimes. But if their own child is sick or has his/her birthday, they are not allowed to leave,” says Sharma.

What is surprising is the great amount of secrecy maintained around surrogate mothers. It is very difficult to speak to a surrogate mother during her pregnancy. Ranjana Kumari claims that CSR was asked to shell out Rs 3,000 to be able to speak to each surrogate mother during the course of her research.

Even Deccan Herald faced a tough time tracking surrogate mothers. The hospitals and clinics would deny interaction claiming that they do not have them at the clinics, or that it was not the time for their visit to the hospital or that special permission is required from the commissioning parents before an interaction can be arranged.

“If everything is so nice and good about surrogacy and the condition of surrogate mothers, why are doctors and clinics silent about it? Why can’t they provide surrogate mothers to speak to,” asks Ranjana.

While these issues and a lot more form the grey areas of surrogacy, the delicate and seemingly less important issue of emotional bond between the surrogate mother and the child is limited to a few Skype calls and pictures sent to the surrogate by a few ‘compassionate’ commissioning parents.