Even as the Draft Assisted Reproductive Technology Bill and Rules, 2010, is being reviewed by the law ministry for a fortnight - it's likely to be introduced in the Parliament's Monsoon session - India's acknowledged 'booming market' for 'cheap' reproductive labour and IVF services is under scrutiny. For many parents, however, going onto the surrogacy 'market', is the only recourse, they say. And India, where commercial surrogacy is allowed, is the destination.Thirty-something Amit Mehta (name changed) insists on being just a voice on the phone. "I am in India," is all he is willing to reveal. Amit has his reasons: two years back, he and wife Sunita chose an agency in Los Angeles to 'commission' a surrogacy for around 28,000 dollars (Rs 14 lakh), a procedure that would have cost less than half in India. "We were at a crucial stage in our careers and my wife couldn't take time out for pregnancy," says Amit Mehta. So we decided to outsource it. We didn't want anyone to know so routed it through US."
Mehta routed it through Los Angeles-based Rudy Rupak of PlanetHospital, one of the several medical tourism agencies that have sprung up in the US that liaise between American parents and Indian clinics/surrogates.
As the Bill shuttles between ministries, in the industry of reproductive outsourcing (estimated to be worth over 2000 crores), wombs can now be hired for the 'best' price and children are delivered through 'low cost' and 'easily affordable' packages. Now, the latest pitch is to offer customised and affordable packages.
This 'boom' is supported by a set of guidelines (designed by the Indian Council of Medical Research) that is one of the most lax regulatory mechanisms for those offering and commissioning surrogacy. (In contrast, most European countries, and Hong Kong and Japan in Asia either explicitly ban commercial surrogacy, or have strict rules governing it.) Add to that the price factor: surrogacy in the US could cost upto 65 lakh as opposed to the 500-odd Indian clinics where costs could work out within 4 lakh - and India wins hands down.
And where there's a market, there are price differentials: between 8 and 22 lakh, the 'commissioning' parents are spoilt for choice. At PlanetHospital, for example, a couple can choose between 'economical' packages starting from around 15 lakh, and offering four transplants with upto four surrogates. The package includes 'recruiting' the surrogate(s) in India, upto four embryo transfers, checking the surrogate's background, her allowances and legal work.
For international couples, egg donors can be sourced from South Africa, Russia, the UK, US and of course, the rising number of egg banks in India, where skin colour, education, background are - almost - for the asking. "Multi-racial babies are considered more attractive," reveals Dr Shivani Sachdev Gaur, fertility specialist at Phoenix hospital, Greater Kailash, Delhi.
There's also another special service: at Rudy Rupak's, you can opt for sex selection, a practice that is legal in the US, but not in India.
"The procedure is done in Panama, where it is legal. Two-three couples from India have already opted for it," says Rupak.
Choice, but for whom?
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 surrogate agents across North India: some of whom boast upto "300 potentials" ready for surrogacy. Indian surrogates are preferred because of "good looks, education and good ethics", including no-smoking and drinking habits, he says.
At the bottom of the 'package' pyramid is someone like Radhika Kumar (name changed), 35, a housewife from Orissa and now a surrogate for an American couple. This is her second surrogacy. And that's where the story starts to get worrying. While Rupak insists he will not allow Radhika, a mother of two, to become a surrogate again, there's no telling that she won't be tempted, especially in an unregulated market where everyone decides the rules of the game. Says Singh: "It's a dirty business. I pay my agent Rs 4 lakh per surrogate, but I am sure they end up paying only about Rs 1-2 lakh."
The ICMR guidelines allow upto 3 embryos transfers per surrogate, but there are packages that promise upto 4-5 embryo transfers leading to the danger of multiple pregnancies and foetal reductions.
Women's groups argue that it's unfair that the surrogate is required to underplay her bond with the child at every stage: she is not allowed to even breastfeed the child. Doctors such as Janakpuri-based Dr Manika Khanna, an infertility specialist, point out to "exploitation" at the hands of the surrogate's husband, who often bargain for a higher compensation, or threaten to terminate the pregnancy midway.
But for Kumar, it's worked out well. At least, for now. "Back home, I lied to everyone that I am away working as a baby sitter in Mumbai for a few months. But it's all for my family's good only."
The proposed bill
The surrogacy market has been largely unregulated. There is the Indian Council of Medical Research (ICMR) guidelines - but they are not binding. Now, the latest version of the Bill is being looked at closely. Its pluses: it includes single parents, reduces the age of surrogates from 45 to 35 years, and makes it mandatory for foreign couples to declare that their countries permit surrogacy. Activists, however, point out loopholes:
The major payment (75 %) to be made only after delivery.
The surrogate can't donate eggs so the infertile couple will need an egg donor. "A surrogate will now be subject to a hazardous and expensive procedure like IVF rather than a simpler one like intra uterine insemination (IUI)," says NB Sarojini of NGO Sama.
Insurance: Provides for 'appropriate' insurance cover for the surrogate. But this kind of insurance and the 'appropriateness' for it is not defined. The responsibility of the commissioning parents post-delivery and follow-up care of the surrogate is also not clear, according to Sama.
IVF cycles: There's no limit to the number of IVF cycles the surrogate will have to go through for one birth.
A local guardian to keep a 'close watch' on the surrogate may hamper her freedom.