Themes > Current Issues
10.11.2006
''Rent-a-womb'': The Latest Indian Export
Jayati
Ghosh
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.
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.
© MACROSCAN 2006