Issue 17 / 19 May 2014

I REGISTERED with an Indian surrogacy clinic last week — not because I wanted a baby, but in the interests of research.

The clinic estimated it would cost me around $38 000 to acquire twins via surrogacy and a premium egg donor, who was an educated woman of higher socioeconomic status or one who had made successful donations in the past.

Type the words “surrogacy” and “India” into a search engine and you’ll be bombarded with clinics — and individual women — offering to provide babies for a fee. It’s a hugely profitable and largely unregulated business with an estimated value to that country’s annual economy of at least US$400 million.

These are commercial arrangements so perhaps it’s not surprising the focus tends to be on benefits for purchasers, with guarantees that surrogate mothers will be educated about the importance of healthy diet, regularly tested for alcohol or tobacco use, housed in hostels for the duration of their pregnancy so their health and behaviour can be monitored, and so on.

Things get a bit vaguer if you start trying to work out the benefits surrogates receive. One clinic said: “We understand the awareness about fertility issues in the Indian population is not high and there are many myths associated with it. Thus this decision of surrogates is indeed one of the most rewarding acts of kindness.

“It cannot be compensated nor valued in money. We believe intended parents acknowledge this as sisterly love, angelic act, and a motherly care; and thus have provided surrogates compensation in different forms, to bring in wonderful opportunities for surrogate and her family…”

The site goes on to say the average compensation received by surrogates in India is 200 000‒400 000 rupees (about $3500‒$7000), but that their clinic has created an “incentive model”, which motivates surrogates to give “complete devotion towards the pregnancy”.

Who knows what that means, but I’m pretty sure the overwhelming majority of Indian surrogates would prefer money to any acknowledgment of their “angelic acts”.

The fees quoted may seem appallingly low to citizens of wealthier countries, but they could be life-changing for a poor Indian family. Like the issue of live organ sales, which I wrote about recently, commercial surrogacy raises complex ethical issues.

As with organ sales, it is possible to see paternalism when the wealthy of the world seek to restrict the already limited options of the desperately poor.

One surrogate told CNN last year she was grateful to have had the opportunity of becoming a surrogate: “I’ve got a chance now to make my life. God has been kind.”

It’s not always that positive. A qualitative study published in Affilia last month explored some of the negative social consequences surrogates may face.

The 15 women interviewed reported being stigmatised by their extended families and communities, to the point where one woman had to leave her village. These poor and illiterate women earned US$3000‒$5000 for successfully delivering a surrogate baby and $4000‒$6000 for twins.

Limited understanding of reproductive technologies, and perhaps reproduction generally, is part of the reason women from poor rural villages may face stigmatisation. In some cases, community members may believe the surrogate has been required to have sex to achieve the pregnancy.

“People in the village think it’s a dirty thing. Old people in the village, they don’t have good thoughts”, another surrogate told CNN.

An anthropological study of surrogates at one Indian clinic found such attitudes led many to try to hide their pregnancy from their communities.

Even the women themselves did not always understand the process they were going through.

Although this clinic sought to educate women that the child they carried would not be genetically related to them, that was a difficult concept for someone with little or no formal education. One surrogate, for example, explained that her commissioning parents were getting a male baby because she was good at producing boys, having had two of her own.

Surrogates at this clinic received no counselling about the risks of pregnancy, let alone the additional risks posed by twin pregnancies.

More broadly, the lack of regulation in India means women may have no access to follow-up care or compensation if things do go wrong.

Attractive as the money may be, when surrogates have as few options as these women do, and when they have limited capacity to understand the medical technologies involved, it’s hard to see how exploitation can be avoided.


Jane McCredie is a Sydney-based science and medicine writer.

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