Surrogacy Article

India’s ‘rent a womb’ industry is booming

For around Dh20,000, there are women in India who are willing to be surrogate mothers for couples hoping to have a child. Helen Roberts reports on the burgeoning womb on hire industry in India

Published:  September 14, 2012

• Women at a surrogate house in Ahmedabad waiting to deliver.

Parvati Lal Bahadur Yep is eight months pregnant with twins. Dressed in a pink and white maternity gown the 30-year-old gently caresses her distended belly as she paces the sparsely decorated room of a house in Ahmedabad, in the western Indian state of Gujarat.

Parvati is trying hard not to get too emotionally attached to the babies kicking inside her. She knows she’ll be giving them away less than an hour after they are born to a couple from South Africa she’s met just once. After all, they have paid her around Rs300,000 (Dh20,000) to carry the babies for them – an unimaginably huge amount compared to the Rs7,000 (Dh464) per month that her husband earns as a driver.

“I have my family – my three beautiful children – I don’t want any more. I’m not getting attached to these babies as I’ll be giving them away,’’ says Parvati, trying hard to mask the emotional bonds she fears she’ll develop with the unborn babies in the course 
of her ‘job’.

What has made Parvati sign up with an infertility clinic in Ahmedabad and give up nine months of her life with her family to stay in the home along with 60 other surrogate mothers is very clear – the money that she will get.

“What my husband earns is barely enough to buy food to feed our three children,’’ Parvati says. “So when my neighbour told me about earning a huge amount of money as a surrogate I got in touch with an agent who put me in touch with a clinic.’’

The clinic Parvati works for – Akanksha Infertility Clinic – has two houses full of pregnant women and it is not the only one in India. There are an estimated 1,000 such clinics in Hyderabad, Delhi, Mumbai and Ahmedabad. Dubbed ‘baby factories’ they have been responsible for as many as 2,000 surrogate births for women overseas last year.

Dr Kamini Patel, the director of Vani IVF Centre, in Ahmedabad, has delivered 48 surrogate babies since she opened the centre nine years ago. “These women live very challenging lives. Being a surrogate has transformed them, and in my opinion, they’re doing great work,” she says.

In 2002 India legalised commercial surrogacy and since then the industry has boomed, making the country a lucrative medical tourism destination. Of the estimated 2,000 surrogate births in India, the majority are in Gujarat. The state has become known as the surrogacy capital of India because it is cheaper, has clear laws and possibly because Akanksha’s director and founder Dr Nayna Patel appeared on the Oprah Winfrey Show in 2007 to talk about surrogacy. The Confederation of Indian Industry, a non-profit organisation that closely works with the government on policy issues, predicts that this year surrogacy will generate $2.3 billion (Dh8.4 billion).

Couples fly to India from the UK and the US hoping to realise their dream of having a baby by taking advantage of the legal and more affordable surrogacy industry there.

But Westerners are not the only ones making a beeline to the fertility clinics. Many infertile couples in India, too, are turning to their country’s surrogates. Bollywood star Aamir Khan and his wife Kiran Rao are two of the high-profile celebrities who have had a baby through surrogacy.

Some couples need an egg donor, while others need a womb as a ‘vessel’ to house their embryos. One thing that is certain, the couples who need a donor or a surrogate live a very different life and come from very different economic circumstances than the surrogates who often live in an impoverished village or slum struggling to make ends meet.

The cost of surrogacy in the US is approximately $160,000 (Dh587,697), but in India it costs a couple between Dh82,000 and Dh118,000 for a surrogate – depending which clinic they choose and how plush they want their stay in India to be. The surrogate gets between Dh17,000 and Dh30,000 and the rest of the money goes to the clinic to cover medical expenses and accommodation for the surrogate.

While most couples dip into their savings to afford the fees, the money the surrogates earn allow them to buy a house, send their own children to a good school and secure a financial future they never dreamed of before. The clinics produce safe and binding contractual agreements with each surrogate that makes it impossible for any loopholes to emerge – as is common with surrogacy in the UK. The strict laws also mean there is very little possibility that the surrogate will fail to hand over the baby as sometimes happens in the UK and the US. Experts say the watertight contracts are one reason India has become so popular and trusted for surrogate births.

Legal and medical protection

The Indian Council of Medical Research (ICMR) has set national guidelines to regulate the industry, and Indian law states the surrogates must sign away her legal rights to the baby as soon as it is born.

To better regulate this growing industry, India’s Health Ministry recently drafted the country’s first surrogacy laws, which set age limits and the frequency with which surrogates can give birth. A woman must be over 21 but less than 35 years old and cannot have delivered more than five times.

Each surrogate can only ‘rent’ their womb up to three times. India’s law prohibits them from doing it any more in order to protect their health. But often, the women give birth to twins or even triplets - up to three times.

However, surrogacy has not been without its pitfalls and dangers. In May, Premila Vaghela, 30, a surrogate for an American couple, died due to complications when she was eight months pregnant. The child was delivered by C-section after Premila collapsed and is doing well.

The process of becoming a surrogate is not easy. The candidates are medically and psychologically tested before they’re given the all clear, says Dr Kamini. The clinics also check if the women already have children so they know whether or not they are familiar with child bearing and delivery. One of the conditions to become a surrogate is that the woman should have delivered at least one child. Most surrogates choose to leave their families for nine months in a bid to keep their actions a secret from in-laws and other relatives.

In Parvati’s case, no one other than her husband and mother know that she is having another couple’s baby. For her, It is imperative that it is kept a secret as her in-laws and some people in her community believe surrogacy is a form of infidelity.

“Even though I have no doubts about what I am doing, I would rather keep it private,’’ she says. “I don’t want people to think badly of me in my community for leaving my family for nine months. I don’t want to take the risk.’’

To prevent too many questions from being asked by neighbours or relatives about her absence, the usual excuse a surrogate offers is that she is going to spend some time at her maternal home due to a medical condition or an ill family member.

Every Sunday the surrogates are allowed visitors, which is when their husbands and children bring them items they have missed from home such as family photos, a favourite dress or even a favourite dish of food. But the couples who hire the surrogate do not visit. “We do not encourage the couples to connect directly with the surrogates to eliminate any possibility of blackmailing,’’ says Dr Kamini.

When Parvati met the couple she is having her surrogate twins for, she was transparent about her reasons for doing this. “They asked me what I would do with the money and I told them about my financial situation,’’ she says. “I also told them that I needed it to give my children a better life.’’ The rooms in the house where the surrogates stay are neat and clean, but bare. There is a TV and a music system, and most evenings the women watch popular soaps.

Around 25 pregnant women stay in each house, and typically there are about five women per room. Keeping all the women in one place suits the clinics as the women can be monitored. Doctors and nurses can make sure they are taking all their vitamins, eating well and having the right ultrasounds. It also means blood tests and blood pressure readings can be taken as often as required.

Surrogate sisterhood

There is unity between the women. They all know they are there to do a job. They support one another and when one is due to give birth the others rally around her.

Each house has a master nurse who cares for the surrogates and makes sure they are medically taken care of and emotionally supported throughout the process. The nurse is trained and qualified and is very often someone who has retired from a government hospital in India. She is very experienced in helping pregnant women.

No cooking is done in the house. Instead, 
a dabba walla (lunchbox delivery boy) delivers a traditional Indian tiffin box, a three-tiered food container, at meal times and the women all 
sit and eat together.

The food is simple but well balanced and nutritious. “We ensure that all her and the baby’s nutritional and medical needs are met,’’ says Dr Kamini.

The beds are simple, and each room has a fan but no air conditioning, even when temperatures hit 40 degrees. But compared to their own huts in slums, that often lack even the most basic facilities, the house the surrogates stay in is palatial.

Fees for the surrogates – who are never told the sex of the foetus they’re carrying – depend on whether they carry a single baby, twins or triplets. The women say they still receive partial payment if they miscarry or if scans detect a problem that results in the termination of the pregnancy – a procedure they have no say over. How much they get depends on how many months along they are. “Yes it would be nice to get paid more… we all want more money. But I want to be here doing this,’’ says Parvati.

She doesn’t think the women are misled or tricked into becoming surrogates – they volunteer knowing the financial benefit their family will receive.

Although there are agents who liaise between the women and the centres, she says once they arrive at the hospital they are given a comprehensive explanation of what to expect from the process and what is expected of them in return.

“We have all got involved in surrogacy willingly. We know what we are doing,’’ Parvati insists. “I’m sure people overseas live very good lives but this is my life and I want to make the best of it. I’m glad surrogacy exists because it’s an option for me to make more money. I’m thankful for that.’’

Although they are doing it for the financial benefits, many women find it difficult to cut the emotional cord that develops during the nine months they carry the baby.

Manuben, a surrogate at Akanksha says: “I had to programme myself not to build any emotional links with the baby. I had to keep thinking this is not my baby and that I am 
here only to do a job. Each job has a requirement and this is the requirement 
of being a surrogate, I guess.’’

Thirty-five-year-old Jaya Ben Raval from Nadiad in Gujarat is married with two children. She is seven months pregnant. “I do have an emotional bond with the baby I am carrying,’’ she admits, stroking her bump.

“Of course you get a little attached to the baby growing inside of you and it’s a little 
hard at the end, but it has to be ended when you deliver.’’

Parvati nods her head in agreement: “As soon as the baby is born I know I’ll think about it for a while, but my love for my own children will be more powerful. In the end, giving birth to this child means I’ll finally be reunited with my own. I don’t know anyone who has regrets.”

The clinics do all they can to ensure there is little bonding between surrogates and the babies they are carrying.

“The baby remains with the surrogate for just an hour before it’s handed over to the couple. The surrogates most definitely do not breast feed – to prevent bonding. There are some clinics that don’t allow them to meet the baby at all,” explains Dr Kamini.

The women leave the hospital as soon as they are able to take care of themselves. In the case of complications, the centre takes care of them offering all the medical help they need. The women are allowed to pay for their treatment in instalments.

Many of the clinics take care of the women even after they have finished working for them. The Akanksha Infertility Clinic has formed the Anand Surrogate Trust, which helps the surrogates after they deliver. A group of women help the surrogates with any emotional or psychological issues they have following the birth. They also help her own children to get a better education and become involved in extracurricular activities at centres across 
the region.

Win-win situation

Akanksha’s founder Dr Nayna believes that surrogacy is a win-win situation for all – something many Indian doctors agree with. 
The doctors also believe that it is in the interest of clinics to take good care of the women involved in commercial surrogacy.

The surrogates are happy to bring a smile 
to the faces of childless couples desperate for 
a child. “I am helping a woman fulfil her dreams while she is helping me provide a better life for my own children. It works both ways.’’ Parvati says.

Manuben says: “The money I get from being a surrogate mother has earned me respect and freedom.’’ Jaya who is sitting on the nearby bed, agrees: “We are choosing to do this so we can better our lives. Is that a bad thing?’’

*names have been changed to protect identities.

Day 22: 3lb upset!

Tonight's weigh in was shocking! Miss Tara finally succeeded in besting her brother, and not only weighs 5 grams more but broke the 3lb mark first by a hair. Vivek was clearly perturbed by this news, because tonight he was so active and restless, throwing his limbs around, making faces, tossing his head back and forth, and even crying on occasion. I was in the other room at one point and realized it was actually my baby crying, because now he has the strength to cry loudly enough to where I can hear when I'm not right next to him, and he sounds more like a baby crying than an angry squirrel like before. I took many, many photos of my mighty man declaring his discontent tonight and of his general expressiveness. If he closed his eyes and rested more and burned less calories maybe he would catch back up to his sister. Sorry pics are blurry, but he wouldn't stay still tonite!


Pensive Vik



Drowsy Vik



Exasperated Vik



Surreptitious Vik



Contented Vik



Curious Vik

 

Annoyed Vik

Miss Tara on the other hand was as peaceful as ever. I have to say tonight holding them both I felt a sense of bonding take over, but partly it is because they seem more alert and I am more confident and less concerned about the monitors desatting so I can just focus on loving my babies. The thrilling news is that so far today I noticed no discernable difference from them being removed from caffeine! So far so good....


Smiling at winning the weight bout finally



Saving her energy for growing bigger



I'm definitely becoming a more confident mother. Miss Tara grunted while I was holding her and I thought I smelled something, and sure enough my detective skills correctly identified a full diaper for the second time. The first one was a loud bomb, so I can't take credit for my discernment on that occasion. I didn't wait for anyone to help and I transferred her back to the isollette and changed it myself. This may sound like no big deal, but at only 3lbs she is still delicate, there are wires hanging off her and she is tangled up in a blanket, and I have to get her off of my bare chest where my clothes are discombobulated and gently transition from sitting to standing with grace and ease. I've developed a method for transitioning to cradle hold first using the blanket for stability, then it is easier and safer to stand up without risking any jostling or bumping.  I was afraid to do much before this point because the nurses watch you like a hawk and don't initially trust you to do things like they would. I was partly waiting to handle my babies more independently until I watched how they did it and they were more comfortable with my handling.


Tara working something out

 I've figured out a new method to get me emotional to help me produce more milk, and so far it seems to be working. When you pump 15 min at a time for 8 times per day you can only stare at pics of your kiddos for so long trying to stir up emotion. So instead I started watching videos on YouTube of babies and then that transitioned into vids of soldiers coming home and greetings by family, children, and dogs. It does the trick! I'm happier with my production level, and if I can put out just a little more I know that the 2-3 teaspoons I can produce per pumping  right now will add up to something that helps my babies. I'm not trying to store and serve it to my babies right now because I lose so much in drops that stick to the sides of the plastic on the way to the bottle, and so focusing on when they attempt to breastfeed in a week or two may be more fruitful. It will also be easier than trying to collect all day for a tiny bit per baby that the nurses will find odd for me to push getting added to their feed of formula and be awkward with the language barrier.

Today Hitesh wasn't in, so still working on FMLA paperwork. It was a bad luck day with tuk-tuks and I must have chatted up 3 drivers for every 1 driver that knew where I wanted to go. This town is not that big, and I typically mention 3-4 nearby businesses to help them be sure the general area I want to go. Frustrating.  I also follow two more generally smart rules:

1. Always name your price first before you get in. Prevents surprises and rip-off's later.
2. If you don't have 40-70 rupees (cost of most rides) then check to make sure they have change if you have 100 bills. They pull this "no change" stuff on you sometimes, which is a load of horse hockey. If they know how to say "no change" they have change, which is typically in their front pocket or hidden in a locked compartment on the console of the tuk-tuk. Maybe if the tuk-tuk is real beat up and the driver looks like they haven't bathed in a few weeks they may have no change, but usually I think they are scamming you.

I went to Dawat again, but despite me seeing eggplant all over town they said no Baingan bartha available. That was the 1 reason I went there, so for the rest of my stay I'm abandoning Dawat and sticking with Decent Restaurant where they have it with corn in it at least.  I ordered spaghetti instead to try "Continental Fare." DO NOT FALL FOR THE SPAGHETTI!!! I've seen it all over menus around town, but it is spaghetti noodles with a super cheesy creamy sauce that is sweetened by pineapple juice. It is like a cheesy dessert thing trying to be savory. It was awful, but they love it around here. I took one bite and very politely told them I wasn't going to eat it, and to my suprise they didn't charge me for it. I felt bad. Then I walked over to Subway and got a veggie patty sandwich to go, where they gave and charged me for chips I didn't ask for, so I guess it evened out.

I met a guy from London and his twins tonight at the NICU, and I'm pretty sure his partner and mother in law. I'm pleased because I thought that Dr. Patel only helped heterosexual couples...but if my guess is correct then that isn't true. That was one serious criticism I had of Dr. Patel was that she wasn't open to homosexual couples or surrogates who were not married, but my surrogate is divorced and these two gentlemen appeared to be a couple.

But tonight ended with some special shots of me holding my son, because he was such a little bundle of energy and I realized I hadn't had many photos of me with the babies except for the first few days. I'll try to include more.

 

And my most favorite pic of all and my new Facebook profile pic:

Day 10: No free rides

Today was one heck of a day. I'm not sure if it is good or bad that my high point of today was changing my little girl's diaper for the very first time. It's impressive how much of something that gross can come out of a baby just over 2lbs. I was given a 2 min time limit and I'd like to think I made my time.

Dr. Hitesh wasn't in until Monday so no taking care of business there, but there was drama across the way at the NICU. It did start off well, and I had an awesome time this morning at bath time taking pics and tons of video. We'll start with finding Mr. Vivek all discombobulated at the bottom ofhis crib with his hat, as usual, cast off to the side.

First up for bathtime was Princess Tara. She splays herself out and waves her limbs around frenetically, but doesn't seem to cry or distress like Vivek does. I think she likes a good portion of bathtime actually. I took two excellent action shots of our princess.

Here is a video of Tara's spongebath adventures:

Vivek on the other hand during bathtime makes adorable squeaks of protest:

Post bath time Miss Tara is quite alert, but Vivek wanted to go back to bed after a quick snack.

But soon after bathtime problems arose. I could tell my little chipmunks were hungry because they were pushing their little tongues out and restless, making sucking and smacking noises.

But the problem was by 9:15, 15 min after feeding time there was no breastmilk.the nurse had told me. I offer to go to Manju's room to see what the hold up is. Several things become apparent:

1. Manju has no pump of her own because the hand pump is shared between her and the other surrogate. I learned later they alternate every two hours who pumps and it is sterilized in between. This gives them four hour gaps and more rest and enables the two of them to produce enough milk...usually. I quickly decide to bring my hand pump at the hotel that I had bought for plane travel and give it to Manju so this won't hold them up anymore.

2. Manju keeps talking in Gujarati expecting me to understand her, and I never want her on my team at charades. She does point to her chest and say something that makes me think she doesn't have enough. I ask about the 2nd surrogate and she points upstairs. I am ticked because I wonder what Nita has to do that is more important than pumping milk for my babies.

I explain the problem to the nurses and Suvarna, the most amazing nurse in the world who is getting a huge tip when we leave, happens to have a 6 mos old baby and assures me that she will provide milk herself if needed to add to whatever Nita brings. I go to the hotel and sterilize my hand pump.

When I return at the next feeding it is apparent some more discussion has occurred, but I'm not sure what. Suvarna tries to tell me something about it when I hand her the pump, but due to the thick accent I have some trouble understanding it. Suddenly both surrogates show up, and I realized Suvarna was trying to tell me she was about to play hardball and take matters into her own hands...literally. She had made my low production surrogate come down so that she could assist her and pump her herself to make sure it was done correctly. She got almost enough milk for both babies but was a few mL shy. Manju did not seem all that happy about being manhandled, but I would like to have seen her more concerned about the welfare of my tiny hungry babies than her modesty.

The other surrogate had a long discussion in front of me with another nurse Anju who speaks some English but not much, and I could tell it was a lively one. The other surrogate Nita had struck me as a little pushy and I had been wary of her. I become increasingly nervous about the content of that conversation as I held my son for the next hour. When Dr. Kothiala comes in later as I'm concluding kangaroo care with Vivek, she compliments my singing and asks me about it. Turns out her CD broke but she had been playing classical music in the NICU based on her music therapy research.

I not so gracefully segueway the conversation into the drama that had been going on with the surrogates and twice delayed feedings due to poor supply. A pow-wow occurs where Suvarna and Anju fill Dr. Kothiala on what had gone on and I finally find out the truth.

Nita is my hero. The reason she had been upstairs was that she was going to all the other surrogates trying to get enough milk for my babies! I am almost certain that this was not the first time she has done this to cover for Manju. She also explained that Manju had been "losing interest" in producing milk for my babies. Don't get me started on how angry that makes me. Either work hard to produce or go home to Ahmedabad, but there are no free rides here. You'll get no sympathy from me because I pump every 3 hrs day and night for the one mL I produce, and she gets a liesurely four hours with meals delivered and no babies to see.  I am not a rich woman and this is not a surrority house. (Punny right!?)

Nita also had a surrogate in mind who would be interested in taking over for Manju so she can go home to her family. I make sure Suvarna and Dr. Kothiala know that I am not paying for someone who is not dedicated and productive in providing for my babies. Dr. Kothiala says I should go to see Dr. Patel's assistant and insist that Manju be cut off and sent home, and today or tomorrow morning they will resolve getting another surrogate to pump for me. Her assitant was very professional and confident and spoke superior English, and I felt instantly at ease. Dr. Kothiala assured me she would also contact Dr. Patel about the matter post haste.

In talking to Dr Kothiala during the whole wet nurse drama, I learn some other good info. In about two weeks we will start using my preemie formula (Similac Neosure) that I brought. She uses breastmilk only until gestational week 32, which should be the end of this month. She does that to avoid NEC (necrolyzing colitis I spoke about in a previous post) but the breastmilk is not as calorie dense and they don't put on weight and grow as fast as they do when you add formula to the mix. She is using some fortifier but explained she has maxed out on that for now. She will also try bottles and breastfeeding at the switchover point because the sucking burns so many calories, she would rather have them on a calorie dense regimen to ensure continual weight gain. I also learn that preemies at this stage in her experience take 3 weeks to gain back birthweight, so all my concerns about Vivek dissipate as he is getting close.

After all the drama I decided I needed to get away for a while and go for a jaunt about town for lunch. I dropped by to see my new friends from NY, and told them I was headed to Subway and they joined me. It was a hilarious ride in a Tuk-tuk. Seeing a guy the size of a middle linebacker cram into one is comical, and when you add two women and the driver...  It's not all that impressive to locals though cause I have seen about 7 folks crammed into one, and even more children on their way to or from school. The sandwiches and cookie were yummy and the second best meal I've had here so far. The place is as tightly in line with the Subway standard operating procedures and appearance as humanly possible in India, and the only main difference aside from localized menu selections were one side is vegetarian and the other isn't. It is a little further away, but worth the trip.

Tomorrow we do Alpha for lunch and will bring some back for my friend with her twins at the hotel, so I'm excited that I'll eat well tomorrow too and help them out again. But mostly, I'm excited for bathtime. And maybe now with having earned trust changing diapers I can look forward to another one tomorrow. How soon will it be before I no longer look forward to changing a dirty diaper, I don't know...