The state support for private sector health care, in the context of economic liberalisation has spawned India’s integration into the global medical tourism industry. This has been policy-led since the last ten years. A subset of this industry is the ‘ART’ industry, estimated to be worth three billion in the US alone. The Internet is awash with advertisements, enticing couples to come to India for infertility treatment and indeed for surrogacy, with a holiday to the Taj or to Goa thrown in for further allure. Indeed a consortium, INSTAR (Indian Society of Third Party Assisted Reproduction), planned to announce its triumphant arrival with a Surrogacy Walk in the capital, New Delhi, on 20 April 2014. More than 500 surrogate mothers, third party administrators, lawyers, doctors and grateful parents were expected to participate. ‘Companies’ offering surrogacy are listed on the stock market.
Within four years of the birth of the world’s first test tube baby in 1978, the Government of India sponsored work on IVF at the Institute for Research in Reproduction in Mumbai. The ostensible justification was a desire to strengthen the success of the population control programme: since child survival could not be guaranteed in India, the possibility of creating embryos in the laboratory and then freezing them might motivate couples to accept sterilization despite their reluctance because of the fear of child’s death after sterilization. The IVF initiative was soon taken over by the booming private health sector, especially the corporate sector with was beginning to emerge with state assistance. According to the Indian Council of Medical Research (ICMR), India had an estimated 250 IVF clinics by 2005 (one of the highest tallies of any country, if not the highest). The Indian Society for Assisted Reproduction now has a membership of more than 600. IVF clinics are now moving in to smaller cities and towns to create and exploit the market in these areas. A senior official at the ICMR has estimated that the revenue generated by IVF and related technologies has leapt five-fold from INR 25,000 crore in 2002 to INR 125,000 crore in 2012. The number of clinics offering IVF also multiplied five times over the same period.
India has now emerged as a prime destination for people outside the country who wish to buy some form of assisted reproduction, either for themselves or for a surrogate. Indeed India is now described as the surrogacy capital of the world, its business worth 445 million dollars. The cost of hiring a surrogate in India ranges from U$6,000 to US$8,000 as against ten times of that, US$80,000, in the USA. The cost of IVF itself in India is about US$500 for each cycle (although there are wide variations), compared to US$5,000 in the USA. Moreover, the ART industry provides a regular supply of leftover ova to the stem cell therapy industry, which is also unregulated in India. This research has corporate and international approval. India has announced a PPP with three European pharmaceutical companies and the British government to carry out stem cell research.
The growth of reproductive tourism to India is justified by its proponents – the government, the assisted reproduction industry , and the middle-men it employs – as a win-win situation: women from abroad, desperate to bear or raise babies with a genetic connection to themselves or their partners, can do so while Indian women earn money as surrogates. But given the highly unregulated nature of medical care in the country, many unethical practices are involved, and ICMR Guidelines governing ARTS are being implemented more in the breach than otherwise. Studies have pointed to the vulnerabilities of the Indian women, driven as they are by quotidian economic concerns to offer their bodies, their fertility, and even their offspring up for exploitation, in a process of servitude if not slavery. Surrogacy is now an international industry, involving a network of actors and agencies, from the global to the local. Many middle-men or third party administrators have emerged to facilitate the process, many of whom have set up NGOs working in rural areas and urban slums to recruit poor women for surrogacy. The government hesitantly stepped in with legislation to regulate this booming market, but the ART (Regulation) Bill 2010, drafted at the behest of the very industry it seeks to regulate, is meant not so much to offer protection to the women surrogates as to create an aura of responsibility and respectability around the industry. By the same logic, the government could ‘regulate’ rather than ban sale of body parts and organs, but opted for prohibition in this case. One justification for reproductive tourism is ‘reproductive choice’ it offers the surrogates, a framework that pays no attention to reproductive or economic justice.
As India integrates further into the global neo-liberal economy it strives to assert itself on the global stage and boasts of an impressive economic growth rate and its ability to withstand global economic meltdown. One way it does so appears to be reproductive tourism and the foreign exchange it generates. The fertility of many Indian women has become a global commodity, as long as the babies to whom they give birth to are those of and for wealthier and/or whiter people -- eugenic, racial, caste, and economic logics still operate.
Women, hitherto considered surplus or waste, whose numbers needed to be controlled, are now to be encouraged to have children, albeit for the global reproductive tourist, converting waste into gold. As the French have it, plus ça change, plus c’est la même chose. India rushes into globalization, by offering sexual and reproductive slavery as globalized commodities.
PUBLIC HEALTH AND PRIVATE WEALTH; STEM CELLS, SURROGATES, AND OTHER STRATEGIC BODIES
Edited by Sarah Hodges, Mohan Rao;
Oxford University Press
PP300, Rs 850