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RENT A WOMB
- ‘The incidence of surrogacy has doubled in the last three to five years’

Shilpa Mehta is visibly pregnant. But the baby she’s carrying is not hers. The real or genetic parents are a Scandinavian couple seated across her in the lobby of an infertility specialist’s clinic in Mumbai.

It is the first time that the couple have met Shilpa, a shy Gujarati woman in her late twenties who has her own child in tow.

Mehta is, in fact, renting her womb out to the couple for a cool Rs 4 lakh to Rs 5 lakh. She carries the couple’s embryo, created from fertilising their egg and sperm in a glass dish. The Scandinavian woman’s uterus has never allowed her to carry a baby to full term. She and her husband were put in touch with Mehta through one of Mumbai’s infertility specialists who, like many others of her ilk, serves as an intermediary between surrogates and prospective parents in India and from abroad.

The Scandinavians are not the only foreign couple to have obtained a surrogate mother in India. Singaporeans Lin and David Lee saved up Rs 30 lakh and decided to take a womb on rent and get the treatment that goes with surrogacy in Mumbai. Lin couldn’t have a child of her own because she was infertile. The couple, which is now expecting a baby through a local surrogate, will be spending nearly Rs 10 lakh on the entire process, far less than the Rs 26 lakh to Rs 35 lakh they would have had to fork out at an in vitro fertilisation (IVF) clinic in California, which they had considered earlier.

And in the United Kingdom, a couple of Indian origin called Bobby and Nikki (surname undisclosed) have been extolling on their web site (onein6.com) the advantages of seeking surrogate mothers in India. For starters, they point out that it costs '100-300 to advertise for a surrogate mother in India versus the '1,000 charged by a British daily. Not surprisingly, an advertisement for a surrogate mother has been appearing in Indian newspapers and magazines in a dozen cities once a week for a couple of months.

To be sure, the quest for surrogate mothers is by no means confined to foreigners. Shyama Kulkarni, a middle- class Mumbaiite, says she was so moved by her sister Suma’s eight-year-long childless state that she decided to be a surrogate for her baby. Suma, she says, shoulders almost all the expenses of bringing up her son, whom she considers her own. “My son calls Suma mummy and me amma,” says Shyama. And Sarla Apte, 22, who is to be married soon, is willing to seek a surrogate mother. Sarla doesn’t have a vagina and both she and her fianc' are open to the idea of using a surrogate.

Indeed, surrogate motherhood is catching on like never before. Several hundreds of middle and lower middle class married Indian women like Mehta, most of them between 30 and 35, make anything between Rs 2 lakh and Rs 5 lakh by bearing babies for foreign and Indian couples. Demand for their services outstrips supply.

Their services are enlisted when women cannot become mothers for a variety of reasons: some have uteruses damaged beyond repair by infections such as tuberculosis, some have no uterus and some suffer from repeated miscarriages. Some just rent out their wombs, but some donate their eggs as well.

And their tribe, as gynaecologists note, is growing in strength. “I have been seeing 10-15 cases of surrogacy a year as against five or six I got earlier. Two or three of them are foreign couples,” says Mumbai’s infertility specialist Indira Hinduja. Adds Krishna Kumar, another Mumbai-based infertility specialist: “The incidence of surrogacy has doubled in the last three to five years. The acceptance is increasing and more people are coming forward to seek surrogate mothers. They prefer it to adopting a child.”

Clearly, much has changed in the last one decade from the time when Chandigarh’s Nirmala Devi spawned a nationwide debate by offering to rent her womb to her employer, as she desperately needed money to treat her paralytic husband and to secure the future of her own child.

What the rules say
Major guidelines laid down by the Indian Council of Medical Research:
• The assisted reproductive therapy clinic must not be party to any commercial element in donor programmes or in surrogacy.
• A surrogate mother carrying a child biologically unrelated to her must register as a patient in her own name and not in the name of the genetic mother. While registering she must mention that she is a surrogate mother and provide information about the genetic parents, such as names, addresses.
• The birth certificate has to be in the name of the genetic parents. The clinic must also provide a certificate to the genetic parents, giving the name and address of the surrogate mother.
• All the expenses of the surrogate mother during the period of pregnancy and post-natal care relating to pregnancy should be borne by the couple seeking surrogacy.
• The surrogate mother would also be entitled to monetary compensation from the couple.
• An egg donor can act as a surrogate mother.
• A third-party donor and a surrogate mother must relinquish in writing all parental rights to the offspring
• A surrogate mother should not be over 45 years of age.
• A relative acting as a surrogate should belong to the same generation as the woman who desires the surrogate.
• A surrogate must provide a written certificate that she and her husband have had no extra-marital relationship in the last six months.
• No woman may act as a surrogate more than thrice in her lifetime.

What exactly is surrogate motherhood' In essence, a woman bears a child on behalf of another couple. This is done in two ways. The husband’s semen can be squirted into the vagina of the surrogate. Alternatively, IVF, a procedure designed to enhance the likelihood of conception, is resorted to. This involves multiple steps, resulting in the fertilisation of the wife’s egg and husband’s sperm to create an embryo. The egg is aspirated through a tube from the uterus through a small puncture in it and combined with the sperm externally. When the man’s sperm count is low, a single sperm could be injected into the egg, externally, through a procedure called Intracytoplasmic Sperm Injection (ICSI). The embryo is formed externally and implanted in the surrogate mother’s uterus.

Like almost everything else in medical care, IVFs are cheaper in India than in the West. In the US, a single IVF cycle is six to eight times more expensive than in India, where it comes for Rs 50,000 to Rs 1 lakh ' or half of what it costs in the UK. The refinement of such techniques and their low cost is what is spawning the boom in surrogate motherhood. And it helps that the amount earned for bearing a child for somebody else can be as high as a middle-class office-goer’s salary for two years or so.

Often enough, money is the factor behind a woman’s decision to rent out her womb. While in India, married women (with a child) are preferred for surrogacy, single women too could choose to be surrogates, but not by resorting to any of the assisted reproductive therapy (ART) techniques. The government has shut the door to motherhood for single women using ART, which figured in the Indian Council of Medical research (ICMR) guidelines.

Explains Sharita Shah, a Mumbai-based psychiatrist: “Many surrogates talk about their desire to do something to better the world, because it sounds nice to say these things. But at the bottom of it, it is financial gain that motivates them.” In Mumbai, Anjali Chabria, another psychiatrist, says: “Surrogates feel that they are doing nothing wrong, that they’re not sleeping around but getting money for their children.”

A few women, of course, act out of altruistic reasons. Nilima, a middle-class woman in Pune, for example, is in the second trimester of her pregnancy. She is carrying the child of a wealthy relative in Australia.

Suniti, a 33-year-old surrogate in Bangalore, delivered a baby six months ago. She says she did this for her husband’s colleague, a 36-year-old doctor who could not bear a child because of her undersized uterus.

But even these reasons, some gynaecologists cynically say, are laced with economics. “It could be either in cash or kind,” says Mumbai-based infertility specialist Hitesh Parekh.

But life is not easy for a surrogate either. How does she, for instance, deal with questions that would be asked by neighbours and relatives during her pregnancy' While some like Shilpa Mehta, who carries the Scandinavian couple’s baby, stay at home till they deliver, others live with the couple seeking a child when the signs of pregnancy become obvious.

The couple seeking a surrogate mother is in a worse predicament. How does the woman explain to a questioning society where her child came from without any symptoms of pregnancy' To fob off embarrassing questions, most women leave their cities or their neighbourhood when they are supposed to be pregnant. School teacher Sharmila Joshi went on leave for nine months to keep up the story of her being pregnant ' and even managed to get a medical certificate endorsing that. Faced with the threat of her in-laws getting her husband remarried if she failed to produce a child, Sharmila got her sister-in-law to be a surrogate mother.

For all the growing hoopla about surrogate motherhood, several snags persist. The ICMR’s guidelines for clinics practising ART and their handling of surrogates are silent on the issue of foreign clients using Indian surrogates in India. So it’s not clear how legal this is. However, Dr R. S. Sharma, deputy director general, ICMR says: “Now with reproductive tourism in India growing, this issue must be addressed.”

Second, those who seek surrogates must be aware that the success rate of IVF is inversely proportionate to the age of the woman. This, as Sudarshan Ghosh Dastidar, an infertility specialist in Calcutta, says, could range between “40-60 per cent in the 30 and below age group, 30-45 per cent in the 30-37 group and 15-20 per cent in women above 38 years.” The quality of the embryo produced, he explains, is determined by that of the egg, which unlike the sperm, deteriorates with age.

Surrogacy throws up another problem. There is always a possibility that the surrogate and the baby will bond. Says psychiatrist Shah: “Post-partum blues are heightened in surrogate mothers.” Sunita, the Bangalore-based surrogate, confesses that she felt like keeping the baby. “I used to weep at the thought of having to give up the baby. I was sad after the baby went away,” she says.

“There are no laws on this. If the surrogate mother decides not to part with the child, there is nothing one can do about it,” notes Hitesh Parekh. And Anjali Chabria stresses that some women could be pressurised into surrogacy by their husbands for money.

It will be a while before the ifs and buts are cleared. Till then, though, the Scandinavian couple ' and Shilpa Mehta ' will make the most of a new business called surrogacy.

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