For many Filipino couples that have a hard time conceiving, they go to Obando, Antipolo, and pray to St. Claire to give them a child. For the rest of the world, there is India.

India, most specially the city of Anand in Gujarat has become known as the “Mecca for surrogacy.” Here, couples do not need to dance or offer prayers. They find a fertility clinic that may provide a familiarization tour that orients them on the process, the available facilities for the care of the surrogate mother, and the roles and financial responsibilities of the commissioning parents and legalities.

Once a surrogate is found, both the commissioning couple and the surrogate undergo counseling to manage expectations. A medical check-up is conducted, and a consent form is signed, signalling the start of the process of the embryo transfer.

At the backend of this operation, some clinics recruit what are known as “agents” or “brokers” to look for possible surrogacy candidates. These agents are usually women who belong to the community and conduct recruitment via word of mouth. They may have become a surrogate themselves at one point. 

The agent must also ensure that the surrogacy candidate satisfies certain criteria: she must be between 21 – 30 years old, married, has at least one child. The candidate must also get the consent of her husband. 

She must have not also experienced complication from previous pregnancy, has no chronic medical condition, and is neither a smoker nor an alcoholic. 

Kinds of surrogacy

“There are two kinds of surrogacy,” explains Ritika Mukherjee, a researcher at the Institute of Population Sciences in India.

Mukherjee presented the results of her exploratory study on commercial surrogacy using Kolkata City as a case study at a recently concluded reproductive health conference held in Manila.

Surrogacy may be done for compassionate or financial reasons, said Mukherjee. In the first case, a woman (who may be a friend or a relative) agrees to have a child for another woman who is incapable or, less often, unwilling to bear children. In the other case, the woman agrees to bear a child in exhange for monetary compensation.

The hiring couple is known as the intended parents or the biological parents, or the commissioning couple and the custody of the child is transferred to the ‘real’ mother immediately after birth.

Commercial surrogacy in India has thrived since the Supreme Court made it legal in 2002. India’s reproductive tourism is estimated to be worth about USD 50 billion. (Read: Surrogacy Laws by Country)

The Indian Council of Medical Research (ICMR) has identified 886 surrogacy clinics across the country. At least 50 such clinics are added every year, according to reports.

“India not only caters its service of commercial surrogacy to the couples of its own country but also to couples from all over the world,” said Mukherjee.

“It (surrogacy) has become a survival strategy and a temporary occupation for many poor women,” she added.

Professional surrogate mothers

According to India’s Assisted Reproductive Technology Bill  (ART), “surrogacy means an arrangement in which a woman agrees to a pregnancy, achieved through assisted reproductive technology, in which neither of the gametes belong to her or her husband, with the intention to carry it and hand over the child to the person or persons for whom she is acting as a surrogate mother.”

The draft ART Regulation Bill of 2010 aims to regulate commercial surrogacy by setting guidelines which include:

• Age limit: Surrogate mother cannot be less than 21 years and above 35 years.
• Maximum number of births: She cannot give more than five live births including her own children.
• Maximum number of embryo transfer attempts: No surrogate shall undergo embryo transfer more than three times for the same couple.
• Insurance coverage: Surrogacy contract should take care of life insurance cover for surrogate mother.
• Sex selection: Sex- selective surrogacy should be prohibited.
• Documentation: Foreigners coming to India to rent a womb will have to submit two documents confirming: (1) That their country of residence recognizes surrogacy as legal; (2) It will give citizenship to the child born through agreement from an Indian mother.

(Read: India’s Rent-a-Womb Industry Faces New Restrictions)

The low cost of surrogacy in India is its main draw. Mukherjee estimated that surrogacy costs in India run from USD15,000 – USD30,000 compared to USD 50,000-USD 90,000 in other countries.

“It is about one-third the cost of Western countries,” she said.

The lack of regulation makes it an easy place to have a surrogate baby, and the availability of younger surrogate mothers who have a higher chance of a successful pregnancy add to the attraction.

Among other benefits, Mukherjee said, “Intending parents also enjoy their names in the birth certificate and assistance for foreign couples during, before, and after the surrogacy along with all legal matters.

Social cost of commercial surrogacy

However, while numbers and currency influx can be documented, the social cost of this thriving industry has yet to be studied.

“The women who agree to become surrogate mothers are usually poor and uneducated. During the counseling and negotiation process, it is difficult to access how much of what is going on she understands,” explained Mukherjee.

In addition, she said, it is a decision that is often not made by the woman alone.

“There is the husband and sometimes, the mother in law there. To what extent are these women given autonomy to speak?” Mukherjee said.

Women who agree to become surrogate mothers must agree to withhold physical contact with their husbands for (as stipulated in her contract) until she safely delivers the baby.  She lives in a hostel or a clinic where clinic personnel who also administer her pre-natal check-ups look her after.  She lives away from her family for the duration of her pregnancy.

It is a high price to pay in exchange for the estimated average USD 3,200 that a surrogate mother is paid in installments.

“These women often tell their children that she has found a job in another city and will come back with a lot of money.”

It is money that is badly needed for a daughter’s wedding, to build a house, start a business, repay loans or send children to school.

“Is it natural for a man with a family but with hardly any or no income to gladly support his wife to accept the offer of renting her womb disregarding the social stigma and health risks attached? A legislation and monitoring is important to control and regulate the surrogacy industry and the people involved,” concluded Mukherjee. – Rappler.com