SEVEN months pregnant, Meena is praying that the child she is carrying will eventually deliver her family a better future. Stroking her swollen belly, the 34-year-old is as excited as any expectant mother, except the baby is not hers.
When the surrogate mother gives birth at Akanksha Infertility Clinic in Anand in India's north-western Gujarat state, the newborn will be handed to a childless American couple.
But because there is currently no standard sum paid to surrogate mothers, there has been a debate about whether the surrogates' interests are adequately protected.
A successful delivery will make Meena 250,000 rupees (S$7,725) richer, a vast sum in her world. Her odd-job labourer husband Haresh would have to toil for 10 years just to earn that. The windfall is a welcome for the couple and their 10-year-old son.
'With the money, I won't have to worry about rent. I can buy a new house. My son will also have an education,' Meena says in her native Gujarati. 'And I am also doing a good deed by providing the childless couple a baby.'
The couple who hired Meena made their way from San Francisco, California, about a year earlier, to begin the surrogacy process. They are among the many desperate couples from around the globe, from Singapore to Switzerland, as well as Indians living abroad, flocking to India with revived hopes of finally having a child of their own. They are drawn by the attractive combination of highly qualified doctors, a flexible legal framework and low costs.
Mr John Lee and his wife, Sue, both 37-year-old Korean-Americans, have been trying for a baby for the last seven years, to no avail. After seven failed intra-uterine insemination (IUI) and three ill-fated in-vitro fertilisation (IVF) attempts, the couple turned to surrogacy as a last resort after reading encouraging testimonies on Internet forums.
'We have already busted more than US$100,000 (S$145,190) in the United States engaging top IVF experts with no results,' Mr Lee says. 'Of course, it helps that it is cheaper over here, as we have already depleted much of our savings trying to fulfil our dream.
'I think this is a major pull factor for most childless couples thinking about surrogacy.'
According to top surrogacy clinics in Ahmedabad and Mumbai, surrogacy cases have soared in the last five years. While there are no firm statistics recorded, doctors say about 500 to 600 surrogate babies could be born throughout the world each year, with around 200 coming from India.
India's average surrogacy success rate is 37.9 per cent - for every 100 surrogacy attempts, about 38 babies are born.
Unsuccessful cases are those where the baby is not carried to full-term, including instances when the surrogate mother suffers a miscarriage or when the doctors are unable to impregnate the surrogate.
Last year, experts estimated the wombs-for-rent industry to be worth US$445 million, with around 3,000 clinics across India offering surrogacy services.
Intending parents are charged around US$20,000 for the entire surrogacy process - from initial consultation to the recruitment of the surrogate, the pregnancy and the baby's delivery.
This may sound like a lot of money but in the US or Europe, the cost of a surrogate baby is about four times more.
Still controversial
DESPITE being hailed as a beacon of hope by many surrogate mothers and commissioning parents, surrogacy remains a controversial issue in India.
The nation was transfixed last year by the case of baby Manji, born to an Indian surrogate hired by a Japanese couple through Akanksha Infertility Clinic.
Manji's prospective parents, Mr Ikufumi Yamada, 46, and his ex-wife, Yuki, 42, divorced shortly before birth, so the baby became caught in a legal tussle for months.
Mr Yamada wanted to take home the child, but Indian law bars single men from adopting children.
Neither his ex-wife nor the surrogate mother wanted the baby, who was dubbed by Indian newspaper The Times of India as the nation's 'first surrogate orphan'.
Manji was finally allowed to leave the country only after the Supreme Court granted custody to Madam Emiko Yamada, the child's 75-year-old paternal grandmother.
Apart from tugging at the national heart-strings, the case set a significant precedent, as the Indian courts now deemed commercial surrogacy to be legal, although it had been going on for years.
However, the Indian surrogacy industry still faces a major test with the upcoming Assisted Reproductive Technology (Regulation) Bill and Rules, which doctors hope will be passed at the next parliamentary session. It is not known when the Bill will come into effect.
Experts say the new law offers greater certainty to key stakeholders. It states a surrogate baby will be recognised as the legitimate child of the commissioning couple, even if they divorce or separate, with the child's birth certificate carrying both genetic parents' names.
The Bill will also make it compulsory for foreigners seeking surrogacy services in India to provide documentary proof that they will be able to take the baby back to their home country.
Another key clause states that intended parents seeking surrogacy through assisted reproductive technology, such as IVF, and the surrogate mother 'shall enter into a surrogacy agreement which shall be legally enforceable'.
If and when the law is enacted, a committee of experts, non-governmental organisations and fertility clinicians will have the right to inspect and regulate clinics that offer surrogacy, says Dr Ajesh Desai, the director of Gujarat's State Institute of Health and Family Welfare.
Dr Gautam Allahbadia, a member of the drafting committee, says: 'All the grey zones in infertility treatment will become black and white.'
In addressing the surrogate's rights, the Bill also proposes that all her expenses shall 'be borne by the couple or individual seeking surrogacy'. It adds: 'The surrogate mother may also receive monetary compensation from the couple or individual, as the case may be, for agreeing to act as such surrogate.'
Attitudes are changing
SOME 450km south of Anand, the bustling financial hub of Mumbai has seen a sharp rise in the number of clinics offering surrogacy over the past five years.
Dr Sudhir Ajja, the founder of Mumbai-based fertility service provider Surrogacy India, believes the industry is set to open its doors even wider, in anticipation of the new regulatory regime.
'Surrogacy is becoming fully legalised, and the guidelines are very specific now. Everybody is okay with doing it,' says Dr Ajja. 'Initially, a lot of doctors were not willing to get involved.'
Critics say, however, proper regulation of the industry is overdue.
Dr H.D. Pai, a council member of the Federation of Obstetricians and Gynaecologists Society of India, believes surrogacy is giving India bad press.
'What is being projected is that India is a lawless market. People are getting exploited and foreigners are coming here to hire wombs. They should regulate it and fix the amounts, so there will be no exploitation,' he says.
But such criticism is rejected by Dr Nayna Patel, one of India's best-known surrogacy doctors and the director of Akanksha clinic. Her profile and that of India's surrogacy industry was raised when she appeared on Oprah Winfrey's television talk show two years ago.
She says her naysayers are just ill-informed. 'I have a surrogate's father-in-law and his son who think IVF is immoral and the surrogate has to sleep with someone else,' she says.
However, attitudes are changing. 'In 2003, I could not find one surrogate. In 2005, I had just 18. But last year, I had 175 surrogates...Now, men are coming to me and saying, 'My wife wants to be a surrogate, too.''
Initially, she notes, doctors placed ads in newspapers to recruit surrogates. Then, as news of this get-rich-quick scheme spread, most applicants either came forth or were introduced by others.
Until now, the industry has been subject only to guidelines set by the Indian Council of Medical Research (ICMR). Critics charge they are full of loopholes that may lead to exploitation. For example, clinics are not audited.
Mumbai-based lawyer Amit Karkhanis, an expert in medical law, says these fears are unfounded, as surrogacy can only be good for India. 'We follow the ICMR guidelines very strictly.'
'A 30-year-old woman who is in need of money can sell her body and sell sex, but it is better that she becomes a surrogate mother. It is a decent and noble way of earning money, plus you make some poor people happy,' he says.
Era of regulation
BUT because there is currently no standard sum paid to surrogate mothers, there has been a debate about whether the surrogates' interests are adequately protected.
Some get as little as 25,000 rupees, according to the National Commission for Women, an NGO based in New Delhi.
Mumbai-based journalist Deepa Suryanarayanan says: 'We are concerned. Does the surrogate mother in India, a woman who usually receives little or no education, really know what is stated in the forms before signing them? Having lived in poverty all her life, would she know whether she is underpaid?'
A quick survey of the going rates in Akanksha's wards is telling. A Brahmin surrogate gets about 300,000 rupees and a lower-caste woman, only half that amount.
Dr Patel is tight-lipped on the exact terms of the consent forms, which are largely about payment and the surrogate mother renouncing her right to the baby. But she maintains that they are translated into the surrogate mother's native language. And each clause is explained to her before she puts pen to paper, she adds.
She is also emphatic the surrogates all willingly hand over the babies after birth.
'Many surrogate mothers regard it not as 'handing over' the baby, but as 'giving back' the baby, as the child was never theirs to keep,' she says.
Meena echoes that sentiment.
'I don't think I will have any harsh feelings about returning the baby to the true parents. I might feel sad, but I know the baby does not belong to me. I will move on and be happy again because both parties will benefit.'
While Meena's husband understands that 'there is nothing dishonourable in surrogacy', she notes that many in largely conservative India still regard the practice as taboo.
'Most people think very badly of surrogacy. They think it means to sleep with other men. So, I don't tell my relatives and friends,' she says.
'It took Madam (Dr Patel) time to explain to Haresh what exactly is surrogacy. But he has been with me all this while, following the procedure, and he doesn't mind now.'
Like Meena, many surrogate mothers are recruited by word of mouth. Still, the supply rarely keeps up with demand. Dr Patel says the clinic sifts out inappropriate applicants hoping to be parents.
'Say, a childless couple comes through my door and the wife wants a baby so bad, but she has a missing uterus, how can I reject this couple? But if a woman says she wants a surrogate to help her carry a baby because she doesn't want the pregnancy to affect her work or her figure, I won't even consider. There are more needful couples to help,' she says.
Also, due to personal convictions, she does not entertain same-sex couples seeking surrogacy. However, the commercial, and by now global, nature of surrogacy has ensured that there are those who will welcome these clients.
One Mumbai-based clinic, Dr Allahbadia's Rotunda Fertility Clinic, has handled the surrogacy cases of 15 same-sex couples - none from India - whom he says now form 10 per cent to 20 per cent of his clientele.
'Ethically, I don't think there's anything wrong. Same-sex couples have their rights to a child, too. It is hard not to be moved by their genuine desire to have a child,' he says.
Legally, there is also nothing to stop gay or lesbian couples from approaching Dr Allahbadia to employ a surrogate's services in India.
However, if the draft Bill is passed without amendment, the long queues at clinics such as Akanksha or Rotunda may become a thing of the past.
India's new draft rules stipulate that couples like the Lees who require the services of a surrogate mother will have to approach surrogacy agencies, instead of going straight to an infertility specialist.
A surrogacy agency, also known as a semen bank, is an independent organisation in charge of providing donor sperm or egg for infertile couples who require such treatments. In terms of surrogacy, these semen banks act as middlemen, matching surrogate mothers to intended parents.
While the proposed changes could help boost the surrogacy industry in India by providing an explicit set of rules and regulations, it may also spell the end of Dr Patel's booming business. And she may not be allowed to keep her personal pool of surrogate mothers.
Although the Bill does not explicitly cast a blanket ban on clinics having their personal pool of surrogates, it states that 'individuals or couples may obtain the service of a surrogate through a semen bank, or advertise to seek surrogacy'. The Bill also forbids clinics from advertising to seek surrogacy for its clients.
In the event it comes into effect, Dr Patel says: 'The law is the law. I will not go against it. A doctor will always put the welfare of the patients as priority.'
This article was first published in The Straits Times.
