Surrogacy is a complex and challenging subject that has been plagued with controversies for the past several decades.  Surrogacy is a good option for a selected few but the unhealthy combination of profit-driven clinics and financially-desperate surrogates, has led to many unethical practices in unregulated surrogacy industry India. Commercial surrogacy in India was legalized in India in 2002. India became the Surrogacy Capital due to excellent standards of medical care and easy availability of surrogates, both at very affordable prices. A study backed by the United Nations in July 2012 estimated the business at more than $400 million a year, with over 3,000 fertility clinics across India. India’s multi-million dollar booming surrogacy industry took a hit after the government banned surrogacy for international patients in 2015, and is on the verge of banning commercial surrogacy for its own citizens as well. These moves have brought what some estimate to be a $2.3 billion industry to its knees. The government's reasoning is that the lack of a legal framework has allowed surrogates to be underpaid and exploited by clinics, which charge between $25,000 and $50,000 for the safe delivery of a baby. Surrogates get between $4,000 and $6,500 from foreign couples and between $3,000 and $5,000 from Indian couples. Agreed, there were no regulatory safeguards for this industry and even the guidelines of the Indian Council of Medical Research were not followed by a big chunk of the ‘reprotech’ industry but a better way around would be to enforce laws to streamline the mess rather than nip it in its bud.

Fraught with ethical, legal and social dilemmas, surrogacy is often blamed to shift the burden of gestation and motherhood from one woman to another, usually for financial compensation. However, it may be the only way for women with absolute uterine factor infertility to have their own genetic child. On the other end of the spectrum are women who are either being exploited or rushed into making the big money. On one hand is the pain of infertility and craving for parenthood, while on the other hand is the commercialization of the reproductive capacity of women. If carried out ethically, it is the biggest boon to infertile women who have a problem with their uteri in order to have their own biological children and a blessing for the surrogates who need those financial resources for better education of their own children. Earning an amount which they would otherwise have to toil hard for years through surrogacy gives surrogates a better quality of life by providing for their family, buying a place to live in, and sometimes, better education for their children. Despite this, many have compared and contrasted surrogacy with sex work. It is hard to tell whether surrogates are exercising their own free will or are being coerced and exploited to fulfill material and financial needs by their husbands and in-laws. Women, as second class citizens in the third world, are extremely vulnerable to commercialization and exploitation.

Undoubtedly, there is also the possibility that surrogacy may be inappropriately used as a convenience for non-medical reasons, and at times, has been equated to a form of dehumanizing labor and ‘organ trafficking’. Women are forced by economic necessity to rent their ‘wombs’ to so-called privileged ones, as observed by Van Zyl (2000) and Ber R (2000). Quoting the legal experts, Anu, et al (2013), have stated in their study that “If surrogacy becomes an avenue by which women in richer countries choose poorer women in our country to bear their babies, then it is economical exploitation, a kind of biological colonization”. A study on the surrogacy industry by NGO, Centre for Social Research (CSR), "Surrogacy Motherhood: Ethical or Commercial?'' supported by the Ministry of Women and Child Development, showed that there is no payment structure for the surrogates.  Around 46 % of the respondents in Delhi, and 44% in Mumbai said they received Rs 3 lakh to Rs 3.99 lakh for being a surrogate mother. Among those interviewed, 68% in Delhi and 78% in Mumbai said that were employed mostly as domestic helps earning more than Rs 3,000 a month. The report also found that some ART clinics are using two surrogates simultaneously to increase the chances of getting a baby. They also observed that expanding surrogacy system is negatively affecting the adoption of orphaned and destitute children. The charges may differ from surrogate to surrogate in many ART centers. Pande (2010) observed that in the absence of any binding law or contract, intended parents have considerable freedom in deciding the amount and form of remuneration. Women recruited for surrogacy are illiterate or semi literate. These women are not given any copy of the written contract, they were not even aware of the clauses contained therein. Most of them do not understand English, the language in which the contract is written. According to Dhawan (2013), most surrogates had minimal understanding of the medical procedures they had been subjected to, and in case of a miscarriage, they received only a fraction of the money. According to Kimbrell (1988), surrogate mothers are unaware of their legal rights, and due to their financial status, cannot afford the services of lawyers, creating possibility of exploitation. On the other hand, there are centers which are ethical, counsel the surrogate along with her husband, explain the process, the benefits and risks, explain the clauses of the contract, and have the compensation included in the surrogate’s contract, so that the intending parents and the surrogate both know exactly how much is being paid to the surrogate. They also make sure that the caretaker is paid by the intended parents, and not by the surrogate. According to Ombelet, et al (2005) and Michele H (2009), malpractices, such as transferring more than 3 embryos at a time, have resulted in multiple pregnancies leading to increased maternal and neonatal morbidity and mortality, as well as excess economic burden.

Gestational surrogacy should be a part of comprehensive infertility treatment program in accredited centers, with a full back up of lawyers, counselors and ethics committee. The government should seriously consider enacting a law to regulate surrogacy in India in order to protect the intended parents, the surrogate, the child born through surrogacy, and the Assisted Reproduction Centers, thus preventing exploitation of any of them. The proposed law needs proper discussion and debate on legal, social, ethical and medical aspects. The main areas to be considered include the indication for surrogacy, complete evaluation of the surrogate, full compensation, legal surrogacy agreements, establishing genetic relationship, readiness to manage unexpected mishaps to the surrogate mother or child, ensuring the child’s custody and having a system of jurisdiction for disputes arising out of the agreement.

With over 3 decades of experience, we at Gynaecworld completely understand a woman’s world and are here to look after the medical hurdles that come your way. You are the center of all our efforts!!!

Book your appointment today at Gynaecworld, Kemps corner, Mumbai
Call: 02223802584
Email: gynaecworldfertility@gmail.com , gynaecworldservices@gmail.com
Visit our website: www.gynaecworld.com