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When
it comes to providing new possibilities for the outsourcing
and offshoring of services, no one can beat us Indians.
The proof of this comes from the latest form of such
offshoring that is increasingly using India as the preferred
location: the phenomenon of surrogate motherhood.
Surrogate motherhood is the process whereby a woman
agrees to carry a child for a childless couple and then
to deliver the baby for them nine months later, usually
in return for some monetary compensation. There are
several forms of this, all made possible by advances
in human fertility technology, mostly notably in vitro
fertilisation (IVF). Typically, the egg from the biological
''mother'' is fertilised by the father's sperm in a test
tube, and the resulting embryo is then transferred to
the womb of the surrogate mother.
It is still very much a grey area in ethical terms.
Different societies have responded to this possibility
in different ways. Several countries, such as Sweden,
Spain, France, and Germany, have banned the possibility
of surrogate motherhood after it was rejected by voter
referendum. Even in countries where it is allowed, there
are restrictions. In Canada, payments are banned in
surrogacy cases, to prevent commercialisation, and in
the United Kingdom only some costs can be provided for.
In developing countries that do allow it, such as Argentina
and South Africa, there are stringent norms mandated
for the process, including case-by-case reviews and
monitoring by independent ethics committees.
There are many reasons for concern. Quite apart from
the purely ethical reasons, the most obvious problems
relate to the risks involved for the surrogate mother.
These include both the physical risks to health and
the psychological and emotional damage that can be caused
by having to part with the child after birth.
The physical risks are obviously greater in the context
of less developed countries where complications in pregnancy
and childbirth are more common and health services are
less advanced. They are also more likely among poor
women, whose general health and nutrition conditions
may make them more vulnerable. It is precisely among
women of lower socio-economic status that mortality
and morbidity associated with pregnancy are higher,
and yet they are the group from which the potential
surrogate mothers are drawn.
But even the emotional concerns should not be underestimated.
Child-bearing is not just like any other work activity
– it is a difficult, complicated and very emotional
process, which completely takes over the life of the
mother, and also involves hormonal changes that generate
feelings. There is a strong possibility that the expectant
mother can develop emotions that make the eventual giving
away of the child extremely difficult. This is actually
recognised officially in several places. In Britain
and in some states of the USA, for example, a surrogate
mother is given the opportunity for some time after
bearing the child, to stake a claim for custody. There
have been several instances of prolonged and bitter
custody battles as a result.
In India, there appears to be less governmental concern
with any such issues, whether they relate to ethical
concerns, or health of the surrogate mothers, or emotional
consequences. In fact, there are currently no laws regulating
the fertility industry, even though there have been
many demands for such regulation. There are only some
non-binding guidelines issued by the Indian Council
for Medical Research, which do not have to be adhered
to either by doctors and medical institutions or by
those seeking to rent the wombs of Indian women.
As a result, there are no such legal or other constraints
in the process of paid surrogate motherhood, which is
even actively encouraged in some states. And of course,
all this is particularly cheap in India, where there
are many millions of poor women with few and declining
livelihood opportunities, who will see this as a way
of making some money.
Of course, the concept of surrogacy per se is not new
to India – think back to the origins of the Pandava
brothers in the Mahabharata. But in India and elsewhere,
it was traditionally confined to female relatives who
undertook this as an act of empathy for the parents.
IVF techniques now allow for a wider range of possibilities,
including some which were previously unthinkable, such
as using frozen embryos from dead parents.
But in particular it has allowed for the development
of commercial surrogacy, for a pecuniary motive. Of
course, this more recent development is not simply as
result of technology - it reflects the spread of commercialisation
to this most fundamental aspect of life.
Already, there has been a spurt in ''medical tourism''
in India, as five-star hospitals staffed by qualified
doctors and nurses (many of whom have been trained through
a highly subsidised public education system) provide
much cheaper and equally efficient services to visitors
from abroad. This same much less expensive system of
privileged health facilities, combined with a large
number of available women of reproductive age, are a
potent combination effectively pushing for the emergence
of ''reproductive tourism''.
The main advantage that India has for childless couples
across the world seeking offspring by these means, is
the cost. Commercial surrogacy in India is available
for rates anywhere between Rs. 50,000 and Rs. 2 lakhs,
but most often at the lower end of this spectrum. This
translates to just a little more than $1,000 as payment
for the surrogate mother. Even with all other costs
included, a couple from abroad can consider ''having''
a child through a surrogate mother for as little as
$2,500 or $3,000, compared to $15,000 to $30,000 in
the US.
But there are other advantages too, especially the relative
ease and lack of regulation which effectively allow
couples to shop around for the best terms and easiest
delivery process. Instead of controls, our laws actually
promote surrogacy. For example, the current laws require
the surrogate mother in India to sign away her rights
to the baby as soon as she has delivered it. Further,
the implanting of embryos into the womb of a surrogate
mother is permitted as many as five times, compared
to a maximum of two times in most other countries.
The market for womb space in India is no longer a furtive
one operating in the shadows. The industry is quite
open and even engages in advertising. One particular
Fertility Centre in Pune has not only advertised its
surrogacy programme for childless couple clients, it
also openly ''invites'' women in the age group 25-30 years
to join up as members of the service providing group!
The poor – in India and elsewhere – are often reduced
to selling the use of their bodies as part of desperate
survival strategies for themselves and their households.
The sale of organs such as kidneys, by those in need,
has been well documented and continues to create outrage.
For some reason, there is less social consternation
about surrogate motherhood. Instead, there is even some
amount of satisfaction among some health professionals
that they have managed to find a new avenue for earning
foreign exchange and employing some of our evidently
underemployed women.
According to newspaper reports, at a hospital in Anand
in Gujarat, the doctor in charge openly celebrates the
''income earning opportunities'' she is providing for
surrogate mothers, who are mostly poor rural women in
need of money. Despite the evidence of surrogate mothers
offering themselves for the job because of the need
to support their families, or provide treatment for
invalid spouses and the like, this is still somehow
seen as purely voluntary. A former Health Secretary
of Gujarat has apparently described this new ''capitalistic
enterprise'' as a ''win-win situation'' and recommended
its extension to poor states in India.
Reproductive tourism is potentially a huge business:
ICMR estimates that it could earn $6 billion in a few
years. Also, as more and more poor women are drawn into
it, they receive incomes much larger than they could
access within their existing livelihood and with their
levels of skill.
So forget about the downside, for to some at least,
there are so many factors in its favour. Perhaps is
it only natural that this new source of foreign exchange
and employment generation is welcomed by elements of
officialdom and the health profession. Who knows, perhaps
this new industry could even beat software in terms
of growth? Perhaps we should even incentivise it, by
providing tax-free status as for the IT industry? After
all, it is but a natural extension of the offshoring
of services that globalisation has brought us.
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