Poverty makes Indian women happy to bear children for infertile western couples who find the costs lower and the legislation less stringent
Dr Nayana Patel says, "Human beings have two main instincts; the instinct of self-protection and the instinct to reproduce." And she should know – she has carved out a career matching infertile couples with women willing to "rent their wombs". Beginning with a couple of surrogacies a year in 2003, Patel's Akanksha clinic in the west Indian state of Gujarat now delivers about 110 surrogate babies a year.
Commercial surrogacy remains controversial and is banned in many countries. But in India, a socially conservative society, surrogacy has thrived since the supreme high court legalised the practice in 2002. A report by the Confederation of Indian Industry estimates the practice will generate $2.3bn a year by 2012.
Women's rights advocates claim that the lack of a clear law on surrogacy and the commercialisation of an unregulated sector have left room for unethical medical practices and the exploitation of both surrogates and infertile couples.
Partly due to pressure from campaigners, the government set out a draft bill last year to limit the age of surrogate mothers to 35, set a maximum of five pregnancies – including their own children – and to make medical insurance mandatory. A further proposal would make it compulsory for prospective parents to show that a child born to a surrogate mother will have automatic citizenship in their home country. The bill also aims to stop clinics sourcing, supplying and taking care of the surrogate mothers themselves.
For now, however, it's business as usual at the Akanksha clinic. When Patel arrives one Wednesday morning, the lobby is full of women. Some wear brightly coloured saris; others are in western dress. They are either desperately seeking a baby or hoping to lift themselves out of poverty and offer their own children a better life.
One of the main attractions of surrogacy in India is the price. Most of Patel's clients are from the US, Canada and Europe. Where it is legal, surrogacy in western countries can cost more than $90,000. At the Akanksha clinic, tucked down a lane behind a chaotic market in Anand, it costs around a third of that. The surrogates are paid between $6,500 and $7,500, the equivalent of several years' income.
When an accident left 32-year-old Ranju Rajubhai's husband severely burned and unable to work, surrogacy seemed the answer to the couple's problems. "I thought I'll be doing a good deed, my work will also get done and [the couple] will also get a baby," says Rajubhai who is due in a month. Like all the women signed on by Akanksha, Rajubhai will receive $6,225, the equivalent of seven years wages for her husband. "I will get my husband's surgery done [for his burns]," she says. "I also want to buy a house. It costs [$14,500 -$18,500] these days. One pregnancy won't be enough, so I am thinking of coming back."
Rajubhai's is a familiar story in the "surrogate house" where she lives with 39 other pregnant women. Owned by Patel, the house is located 10 minutes away from the clinic. With two to three iron-framed beds in each room, the house has the look of a hospital ward. The surrogates, clad in loose, colourful gowns, are sitting, lying, stretching, watching TV or chatting with each other. In one room, hangs a picture of a crawling toddler with the words: "The time to be happy is now."
The majority of the women are second-time surrogates and will have caesarean sections. "We have to cut our stomachs for money," says Anjuman Pathan, a blunt, 30-year-old. "It's not a bad thing, is it?"
Life at the surrogate house creates a sense of sisterhood. The women enjoy the rest and care they may not have had during their own pregnancies but are confined to the house for the whole pregnancy. Their families can visit on Sundays but the surrogates only leave the premises for medical check-ups or if there is a family emergency.
"When I used to go, I would just see the surrogates lying around all day," says Kantibhai Motibhai, the husband of two-time surrogate Shardaben. "They count the days to go back home. [But] I guess it works well. Our main interest was in the money. Their main interest is in the baby." Sharda's two surrogacies have allowed the couple to lease some land, buy buffaloes and a motorbike, have money for their children's education and start saving. As second-time surrogate from Nepal, Diksha Gurunga, puts it, "You have to lose something to gain something and what we gain is a lot more than what we lose."
The experiences of the expectant parents are very different. "I would go and pick up a baby on the street," says 38-year-old Jennifer, a tall American who has had five failed pregnancies. "That's the kind of desperation that comes with infertility."
Slender-framed with green eyes and cropped blonde hair, 38-year-old Robyn Wright runs a beauty salon in Wilson, Wyoming. She has a 14-year-old daughter from her first marriage, but a haemorrhage following the birth led to a hysterectomy. When she met Jason, a guide at Yellowstone National Park, the couple wanted their own biological child. The Wrights admit they "weren't born rich" and don't "live on credit". Realising surrogacy in the US was financially impossible, the couple took their savings and travelled to Gujarat to fulfil their dream.
Patel says laws governing surrogacy in the US, for example, are weighted too much in favour of the surrogate mother. "There are so many cases where you are the genetic parent and [the surrogate mother] is blackmailing you. She will not give you the baby ... If you don't pay, you're not allowed to see the baby. Couples from abroad write to us saying that the legal liabilities are so much in the US, that after paying so much money also, I don't know if I'm going to hold my baby or not and that is what India has taken care of."
She is in favour of regulation in India but sees ethics as more important. "See sex determination. It's rampant in India but it's illegal. So whatever you do, there's going to be unethical behaviour. It's the ethics of the couple, surrogate and doctor, which counts."
Back at Patel's clinic, three women who come from North America to find a surrogate mother are gushing over a newborn European baby recently born to one of the surrogates at the clinic – proof that their dreams could also come true. "There's no perfect system, but given what we have and under the circumstances, Dr Patel's clinic definitely helps create miracles," says Fatima, a Canadian of Indian and Chinese heritage.
Gupta, Davya. 2012. "Inside India's surrogacy industry". The Guardian. Posted: December 6, 2011. Available online: http://www.guardian.co.uk/world/2011/dec/06/surrogate-mothers-india