In a new study brought out by the Centre of Social Medicine and Community Health, JNU, Sama-Resource Group for Women and Health and King’s College London, entitled ‘Reproductive Tourism in India”, India has emerged as the surrogacy outsourcing capital of the world.
Expansion and proliferation of Assisted Reproductive Technologies (ARTs) has been facilitated by economic globalisation. The key features of globalisation, such as crossing boundaries, the increased role of markets in health care, the state’s withdrawal from provisioning, are all significant in the context of ARTs. A transnational fertility market is created wherein reproductive tissues like sperm, ova, and uteri are traded like any other commodity to make profit. A business newspaper has even suggested that as an integral part of the growing medical tourism industry, the fertility industry is “slated to bring in additional revenue of $1–2 billion by 2012”.
From the high-end corporate hospitals such as Apollo and Medanta, to multi-speciality trust hospitals such as Gangaram, to large public sector institutions such as the Maulana Azad Medical College and the All India Institute of Medical Sciences (AIIMS) and to nursing homes and single-doctor clinics, a large number of institutions (in Delhi) offer Assisted Reproductive Technologies (ARTs).
AIIMS hospital in New Delhi
The public sector institution offers surrogacy services where medically indicated, but only altruistic surrogacy. The leading obstetrician and gynaecologist from a top public sector institution admitted that they have performed IVF in some cases where they were not sure if it was altruistic surrogacy. In short, this is not what they probe in great detail, but they do not themselves find women either as donors or surrogates.
At the trust hospital, the focus is on infertility and IVF, not on surrogacy. They perform about two to three surrogacy births a year and about a hundred IVFs. The commissioning couple brings the surrogate. The doctors ask no questions, but make sure the papers are in order. The hospital does not cater to foreign clients, but has had NRI (Non Resident Indian) clients. Their charge is the same whether for IVF or surrogacy – INR 1 lakh per cycle. Their charge is also the same whether or not the couple is Indian or NRI. The doctor felt ‘masala’ media coverage had in fact boosted the industry that sorely needs regulation.
Sushmita Sen plays a surrogate mother in the 2002 movie, Filhaal.
Vicky Donor (2012) brought the topic of sperm donation to mainstream attention
At the only private hospital that agreed to be interviewed, the doctor said that she had been providing IVF services since the early 1990s. She offers this service with the assistance of a reliable third party agency that handles all legal and other issues, dealing only with the medical aspect, till a pregnancy is successful, after which an obstetrician takes over.
All the respondents agreed that the Bollywood actor Aamir Khan had provided a boost to the ‘industry’ (when he chose this route to have a baby with his wife, Kiran Rao), not seen as the most desirable or idealistic option.
There are hostels run by doctors for surrogates where they could be monitored and supervised against ICMR guidelines. On the other hand, surrogates clearly need such institutions since they need to stay away from home for a long period and then return claiming that they had been away on work. Many of the commissioning couples also prefer the surrogate to stay in a hostel so that they could be in regular contact with the surrogate, and, indeed, bond with her, even as the doctor keeps an eye on her and supervises her diet and medication. The surrogate’s husband and children are permitted to visit her regularly.
These doctors have been in this field for twenty years or more and have in a sense been participant observers to the growth of the ART. All of them are members of Federation of Obstetric and Gynaecological Society of India (FOGSI) and Indian Society for Assisted Reproduction (ISAR). In the public sector institution, post-graduates are trained in assisted reproduction. The other doctors interviewed, one from the trust hospital and the other from a clinic, are also involved in training workshops as members of ISAR.
Many couples were inspired by Aamir Khan and Kiran Rao who opted for IVRF pregnancy Pic: Wikimedia Commons
Unless the Bill is passed into law, there is only a bleak picture of unregulated proliferation of the ART. This is partly related to the demand factor, but more significantly due to the supply factor. The ART offers better rates of return on investment, second only to the radio-imaging industry (body scanning etc), where capital requirements are much higher.
There are some serious regulation concerns where respondents are of the view that highly exaggerated claims of success are being made. In view of the severe shortage of embryologists, people not adequately qualified are also passing off as embryologists. There are no standard guidelines for facilities and the practice. There are no uniform rates for charges and payments.
Among the unethical practices repeatedly mentioned by all respondents are: 1) The harvesting of up to 20 eggs; 2) The insertion of any number of embryos; 3) The widespread practice of embryo sharing.
It is common knowledge that embryo sharing occurs. Patients have been advised by doctors in the past about the deficient quality of eggs/embryos and offered to facilitate a good embryo donor. Couples have been charged anything from INR 20,000 to 50,000 for the embryo donation they received, but that pregnancy had not occurred. They have no papers at all to verify anything, but they invariably say they had signed the legal consent papers for this.
The need for surrogacy to be regulated is undoubted. But there is also cynicism about being able to regulate anything in our country. The ICMR guidelines need to be made into law. That will create a good deal of transparency because the clinic cannot then deal directly with surrogates, the ART banks will. This separation is essential. The registration of such banks would also mean that middlemen, who now thrive, would be weeded out. But questions were also raised about ICMR’s ability to implement the law when it is passed.
