Surrogacy Clinics in India — a New Twist on Outsourcing

By Brian Cole

Published on February 01, 2008

A growing number of infertile couples from the U.S., Britain, and other Western counties are finding that the path to parenthood leads them to Asia. These couples are not seeking to adopt, however. In a controversial combination of biology and international commerce, Indian women are acting as surrogates - carrying the biological babies of foreign couples - at cut-rate prices.

Surrogacy utilizes in-vitro fertilization. Through this treatment, couples who are unable to conceive, but are able to donate egg and sperm samples, can have a child with their genetic traits. In a practice known sometimes as "rent-a-womb," "outsourced pregnancy," and even "baby farming," the surrogate gives birth to a child to which she has no biological connection.

In a twist on the recent trend of outsourcing work to India, clinics are connecting couples with Indian surrogates at a fraction of the cost of domestic surrogacy services. When compared to the typical $80,000 cost of surrogacy in the U.S., for example, the less-than-$10,000 fee typically paid for surrogacy services in India is nominal.

The Epicenter of International Commercial Surrogacy

Dr. Nayna Patel has turned Anand, which has traditionally been the milk capital of India, into the world center of international commercial surrogacy. In India, surrogacy is now a $445-million-a-year business, and growing.

Couples from around the world are now traveling to India, where, with the help of intermediaries like Dr. Patel, ready and willing surrogates await. By acting as a surrogate, an Indian woman can expect to earn roughly ten-to-fifteen times her family's annual income.

The Women of Ananda

With a small clinic in Kaival Hospital in Ananda, Dr. Patel not only matches infertile couples with local women, but provides all other services related to the surrogacy as well.

Each couple typically makes two trips to India during the process; once for the in-vitro fertilization and another for the actual birth.

The surrogates Dr. Patel works with live together in a house rented by the clinic. Here, women are cared for by a former surrogate, receive visits from family and friends, and obtain what is reportedly excellent prenatal care. They also receive counseling after the birth to address the potential trauma of handing over the baby to the parents.

Parent and Surrogate Requirements

Indeed, the complex psychological factors that surround carrying - and connecting to - a child pose a real danger when it comes to surrogacy, even though the child has no genetic relationship with the surrogate. To help minimize the psychological impact of parting with the baby that had been growing in her womb, each surrogate at Dr. Patel's clinic must have children of her own to go home to.

In an attempt to protect the interests of all parties involved, a contract is signed by both the surrogate and the parents. This contract states that the couple will cover all medical expenses in addition to the surrogate's payment, and the baby will be handed over to the parents after birth.

Criticisms of International Surrogacy

While Dr. Patel sees this practice as a win-win scenario, others view it is as an exploitation of women through global inequalities. Such critics contend that it should be the focus of the worldwide community to foster equality and increased education for woman in developing countries, not to create a surrogacy industry that exposes woman to the risks of pregnancy for financial gain.

Dr. Patel contends that, because surrogacy allows infertile couples to have a child, and surrogates are provided with enormous financial rewards, her practice is performing a vital service to all involved. Indeed, bringing the joy of parenthood to an infertile couple is a strong, if often secondary, motivation for many Indian women who choose to act as surrogates.

Banned

With France, Germany, Italy, Canada, and a number of U.S. states banning commercial surrogacy within their borders, the practice has its share of detractors. "The human body is not lent out, is not rented out, is not sold," France's highest court held when it outlawed commercial surrogacy in the early nineties.

"It comes down to questions of voluntariness and risk," said Dr. John Lantos of the Center for Practical Bioethics in Kansas City, Missouri. For Dr. Lantos and others, the financial gains offered by commercial surrogacy, along with the poverty of rural India, lure many women to put their health at risk.

Safety for the Surrogate and Child

With the sparsity of adequate health care in India, especially in rural areas, Indian women tend to be at higher risk of complications during pregnancy than those in more developed countries. When it comes to commercial surrogates, however, this does not seem to be the case.

Many supporters of commercial surrogacy point to the quality of care provided at Dr. Patel's clinic and similar facilities as evidence that surrogates are putting their health less at risk than the average pregnant woman in India. In fact, most of these clinics are able to provide - with help from an influx of Western currency - top-notch care.

Lingering Questions

While the benefits of surrogacy may be evident, questions still remain. 

Stories of surrogacy in the Unites States and other Western countries are not typically framed in the context of the poorest of citizens acting as surrogates out of financial desperation. Often, a family member or friend offers to be a surrogate for a couple in response to their not being able to conceive. It is hard to imagine these couples going to clinics in poor rural areas, or on the streets of inner cities, in search of a surrogate.

This is where the ethical line starts to blur. Are couples who use an Indian surrogate to have a child living out their dreams and helping a poor Indian family? Or are those seeking surrogacy in India taking part in something that they would consider immoral if it were happening just down the road? There are no easy answers to these questions, of course. However, for many couples, the joy of finally having a child of their own makes these questions purely academic.