In Ahmedabad, Gujarat, my driver is looking for one of the city’s IVF clinics. We turn on to a busy main road and I spot a sign on a crumbling wall reading “test tube babies”.
I climb the filthy stairwell and enter a small, dark reception area. In the adjoining room I spot a hospital stretcher and shelves full of metal petri dishes, forceps and hypodermic needles.
Dr Rana* leads me into a windowless office. Before we even sit down, he is telling me about a change in India’s surrogacy policy.
In October last year, the government told fertility clinics to stop all surrogate embryo transfers to foreigners. The move follows a proposed change in the law that would limit surrogacy to Indian couples, or where at least one of the commissioning parents has an Indian passport and residency.
Having established that neither I nor the woman posing as my husband’s sister own an Indian passport, Rana advises me to go to Thailand.
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“It costs twice the price [that it does] here,” says Rana, “but they will even do sex selection, so many people will go from India.”
Having heard many stories about how commonplace outsourcing pregnancy and reproduction is, I am in India to investigate the country’s “rent-a-womb” industry.
As a feminist campaigner against sexual abuse of women, and in particular the sex trade, I feel sick at the idea of wombs for rent. Sitting in the clinic, seeing smartly dressed women come in to access fertility services, all I could think about was how desperate a woman must be to carry a child for money. I know from other campaigners against womb trafficking that many surrogates are coerced by abusive husbands and pimps. Watching the smiling receptionist fill out forms on behalf of prospective commissioning parents, I could only wonder at the misery and pain experienced by the women who will end up being viewed as nothing but a vessel.
Stigma is rarely an issue for those who outsource pregnancy to poor, desperate women in India, but there is plenty levelled at surrogate mothers. Many choose to leave home during their pregnancy, as it is not seen as a respectable way to earn money, particularly if they are from rural India.
Commercial surrogacy is illegal in many countries, the UK, France, Germany, Italy and Spain among them. In India, though, the industry – built on sex, race and class supremacy – is not only legal but estimated to be worth more than $1bn (£690m) a year.
Surrogates are paid about £4,500 to rent their wombs at this particular clinic, a huge amount in a country where, in 2012, average monthly earnings stood at $215 and a fifth of people live below the national poverty line. Clinics can make up to £18,000 from commissioning parents. The cost of bringing home a surrogate baby from India is approximately five times less than the sum charged in the US.
But while surrogates are usually from poorer backgrounds, the implanted eggs are selected from women up to the age of 25, usually highly educated and screened for any hereditary illness.
All surrogates who go through these clinics are told what and when to eat and drink, and monitored to ensure they are taking their medication and maintaining their personal hygiene.
A “residential colony” is being built with money donated by several fertility clinicians to house up to 10 surrogates during the course of their pregnancy.
I decided to visit four clinics in Gujarat, one of India’s most religious states – known as the country’s surrogacy capital – posing as a woman interested in hiring a surrogate and egg donor to gain access to those providing the services. I wanted to be able to speak from experience about the human rights abuses that result from the practice, and to become more involved in the international campaign to abolish it.
I was told it is common practice to plant embryos in two or more surrogates and to perform abortions if more than one pregnancy takes hold. Similarly, if several embryos are implanted in one surrogate and a multiple pregnancy occurs, unwanted foetuses will often be aborted.
Approximately 12,000 foreigners come to India each year to hire surrogates, many of them from the UK.
‘We will show you a catalogue and you can choose the surrogate’
The second clinic I visit is in a quiet, suburban area of Ahmedabad, the largest city in the state.
Having spoken to the receptionist, I am introduced to an administrator who takes my medical history. I tell her I want to access egg donation and surrogacy services, and she tells me they “do all of that”. I ask if the surrogates live in a hostel during pregnancy, which I had seen on television back home, and she shakes her head. I’m told I can pay for a woman to be housed for nine months, “or if you want to save money do it for a bit and then send her back home”.
In each of the clinics I visit I ask how much the surrogates are paid. No one would give me an exact figure, but one doctor told me that the women earn six years’ income for nine months’ work.
At 11am, on the eve of Diwali, the ancient Hindu festival of light, one clinic is busy. Several women are applying to become surrogates; some of them, seemingly illiterate, ask the receptionist to fill in the forms for them. Others, well dressed, smiling, and accompanied by their husbands, are waiting for appointments. At least 150 women accessing IVF treatment attend the clinic each month.
I am told the clinic can do nothing for me. “Because of human rights the government is now closing [surrogacy services]. Maybe it is because the children are not treated well,” says one of the doctors. I had never previously heard of children born through surrogacy being harmed by commissioning parents, but there have been cases where children have been abandoned and left in India with the birth mother. In 2012, an Australian couple left behind one of the twins born to an Indian surrogate mother, reportedly because they could not afford to bring up two children.
The next morning I am booked in for a consultancy at a third clinic, with Dr Mehta*. After filling in several forms, with questions about my history of infertility, I pay my 1,500 rupees (£15) for a consultation. I tell Mehta that my friend Lisa, with whom I’m travelling, is of Indian origin, and willing to be the official commissioning parent and then hand over the baby to me. I ask about egg donation, and how I choose the donor.
“Egg donation is by an anonymous donor. You can give us preferences, such as height and hair colour, but you will have to rely on us,” says Mehta. “The donor will not know to whom her eggs are given and you will not be knowing whose eggs they are. The surrogate will meet you. We will show you a catalogue and you can choose the surrogate.”
All four doctors I meet in Gujarat tell me it is bad for the women to be removed from home during this period, but all were willing to arrange this. For a price.
“We can do that if you are willing, but you will have to pay for that,” says Mehta. “We don’t want to separate the surrogate from her family because if she lives from two to nine months in a separate room and environment then it will affect her mental health.”
I have heard several stories of women being forced or coerced into surrogacy by husbands or even pimps, and ask Mehta if she is aware of this happening.
“Without the husbands’ [of the surrogates] consent we don’t do surrogacy. We don’t give all the money before the delivery. We take from you but we hand it over to her once she hands over the child to you. We give her in instalments so she will also take care she will deliver the baby no problem.”
Mehta said they try to avoid the women forming bonds with the baby by giving them drugs to stop lactation. “She will not produce milk at all and she will not be shown the baby.”
Some of the women sell their breast milk, extracted by a pump at the clinic and delivered to the commissioning parents. Others agree to be paid to directly breastfeed the baby, despite the likelihood of bonding.
The Indian Society for Assisted Reproduction is planning to challenge the Indian government on the proposed law change. “There are millions of dollars in IVF cycles,” says Rana.
At another clinic in eastern Ahmedabad, I meet Dr Amin* in a run-down building hidden between a garage and an electrical goods store. The cluttered office is windowless. Covering the walls are photographs of newborn babies, and thank you cards from the commissioning parents.
Amin hands me some photographs of potential surrogates, while explaining the fees for egg donation – “caucasian donors £2,500 to £3,000, Indian donor £1,000”.
The surrogates remain at home during their pregnancy and are monitored daily. “I don’t allow the women to live in surrogacy house,” says Amin. “The husband is the better watchman I feel. He is involved in the programme – he knows how to take care of his woman. Outside, if she’s alone she will have many friends and [it will be] difficult for me to control. Even if I put them in a hostel I never know what is going on there.”
I ask if the women ever experience domestic violence during pregnancy.
“Rarely, but we have seen it,” says Amin. “Last year we heard a surrogate’s husband was beating her. She came crying to us so we put her up. After the child was born we sent her back.”
According to Amin, the surrogates she hires are middle class or upper class. “Recently we [hired] three Brahmin [a high caste] girls, all educated. We have about 25% of that class. About 85% [of all surrogates] are quite well off.” I suspect this is a lie. Research by pressure group Stop Surrogacy Now shows that, aside from rare cases, it is the poorest women from the lowest castes who become surrogate mothers.
We discuss the recent change in policy, and Amin tells me about a surrogacy clinic in Hyderabad that produced five children for a gay couple from five individual surrogates. Same sex couples have been banned from accessing surrogacy services in India since 2013, but, as one clinician told me: “It is still going on in Delhi and elsewhere, because this is not a regulated industry.”
As we are leaving the clinic, Amin points to a photograph on the wall of a white woman holding a brown baby. “She asked for an Indian egg donor.” I ask why. Does she have an Indian partner, for example? “No, she wanted a baby with black hair,” says Amin, beaming as she takes my 1,500 rupees for the consultation fee and shows me the door.
* Names have been changed
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