Are women baby-making machinesIJ The proposed Surrogacy Bill 2016 seeks to ensure that they aren’t reduced to that status, but there is also an alternative argument against it. ANANYA BORGOHAIN explores both sides of the debate on commercial surrogacy ban
A middle-aged surrogate mother in an Indian village, who wishes to be unnamed, celebrates a child’s birthday around this time every year. She does not know its name, gender, or address. She does not even know if it still exists, but she thinks of it very frequently and prays for its well-being as sincerely as she would wish her own children’s safety. She had given birth to this child some years ago at a fertility clinic and as soon as the child was born, it was taken away from her. She did not even catch a glimpse of it.
On the other hand, lakshmi, 30, entered the profession 14 days ago. She has come all the way from Gurgaon to Mandi House at the Delhi IVF clinic to get her shot. “I approached them through an agent. I have two girls of my own, but this is the first time I am doing it. My family is aware of it and I am not scared of what lies ahead either,” she says.
Is power a tool or the objective of coercionIJ Is it power that creates knowledge or knowledge that creates powerIJ If there is no certain truth, how does the power-knowledge nexus operate in creating a world that thrives on activities and information that have been internalised generations after generations, until they became norms and moral dictums of societyIJ These questions arguably apply the most in parenting. The obligation to bear children is so deeply nurtured in any social structure that distancing oneself from it is a stigma. Perpetuating a family name, enjoying parenthood, and having children around the house have become such important markers of peace in one’s life that a childless life is seen akin to disgrace and misfortune. The pressure to have children merged with the frustration of being unable to bear them has ironically created miraculous scientific inventions (read IVF) as well as boosted the rise of the womb industry, however warped that may sound. And caught in this tryst of aspirations and failures is the burning issue of surrogacy — in all its ideological, social, cultural, and political facets.
Surrogacy has always been a debatable topic. Countries such as Germany, France, and Italy have already banned it whereas the UK, Canada, China etc allow certain forms of it. While in India, the revised Surrogacy Bill of 2016 has been a cause for concern in many ways. For the uninitiated, traditional surrogacy is the artificial insemination of an already fertilised egg of the woman (the surrogate) who will give birth to the product, the child, on behalf of who will be its official mother. In gestational surrogacy, it is the genetic mother’s egg that is fertilised and artificially inseminated into the surrogate mother, who in turns carries it for the genetic mother.
Surrogacy primarily exists in two forms: Altruistic and commercial. In the former, the surrogate is paid no money and only her medical bills are taken care of. In commercial surrogacy, the surrogate earns a sum for her services. The new Bill bans commercial surrogacy entirely and allows altruistic surrogacy under certain conditions. Some of them include: Only Indian couples who have been married for at least five years and at least one of them clinically proven to be infertile could opt for surrogacy; the surrogate mother must be a close relative; a couple that already has a child cannot commission surrogacy; unmarried, homosexual, live-in couples are banned from opting for surrogacy, so are NRIs and foreigners.
This has been done in an attempt to control the alleged exploitation of surrogate mothers, who, almost all the time, come from underprivileged, financially unstable families and need the money for survival.
In vitro fertilisation (IVF) in India was invented in 1978, and is today a multimillion dollar industry, more so after commercial surrogacy was legalised in the country in 2002. The fundamental argument against surrogacy is that by luring the surrogates with money, their bodies are subjected to extreme medical experimentation to impregnate them Several hormonal injections, force stopping their menstruation, no-reason caesarean sections, force stopping surrogates from lactating, inserting synthesised hormones, and so on are said to be steps that the surrogates go through in order to conceive. Are women baby-making machinesIJ Seeing this as a brutal form of bonded labour, the Bill seeks to ban commercial surrogacy and limit altruistic surrogacy.
Shailaja Chandra, former Secretary in the Ministry of Health and Family Welfare and the Chairman of the Public Grievances Commission and Appellate Authority under the Delhi Right to Information Act, says: “A poor woman can earn anything between Rs1-3 lakh from surrogacy, and with debts and growing expenditures hanging over her head, she agrees or is forced to agree. In most cases, it’s actually the women’s relatives and middlemen who compel them to go through it.”
She adds that the myths around being childless and the reluctance to consider adoption need to be addressed through proper awareness campaigns, and adoption promoted as a first choice. “Not only is that humane, but is also less exploitative on the surrogate, who has to be bolstered with hormones to prepare her to accept the embryo.”
Chandra also believes that IVF centres need to be registered. “The process should be open only to Indians or if one partner is of Indian origin. We must not permit foreigners to enter into surrogacy arrangements because it is akin to using Indian women to make a takeaway baby for them. While foreigners are generous in looking after the woman’s health and nutrition, problems of citizenship, and fulfilling the responsibilities attached to accepting the infant, even if it suffers from physical or mental deficiencies, can arise.”
About how it can be checked if the ban is being upheld once the Bill is passed, Chandra says, “Such a law, if made, will remain like so many other laws — unimplementable. There is no machinery to police what happens between two or three people by mutual consent; desperate couples and future surrogates’ families will find a way of doing it secretly. Can a woman who leaves for her native village for nine months be taken to taskIJ It’s tough to push such laws. Do you think kidney transplant rackets have stopped and all such transplants are altruisticIJ”
At the same time, many doctors and fertility centres would disagree and present another side of the debate. The Delhi IVF & Fertility Centre is considered to be one of the finest for infertility treatment in the Capital. It was founded in 1993 by Dr Anoop Gupta. His daughter, Aastha Gupta, a gynecologist and infertility specialist, says: “We have handled hundreds of cases from all over the world in the past seven to eight years and they have all been done without any compromise on health, of both the surrogate and the child. We hire the surrogates through official agencies that approach us on their behalf. This is a completely legal process. We ensure that the surrogates are healthy and have also been mothers in the past. They live in their own homes with family and keep their health in check during their regular visits to the centre.
“There has also been no case of a surrogate’s emotional conflict upon having to let go of the infant she gave birth to. They are all professionals and understand the nature of their job. And neither do we put them through detrimental medication. Say, we don’t force stop them from lactating or give them any unnecessary medication.”
The cost of the overall IVF procedure, Dr Gupta says, may be Rs8 lakh approximately, of which the surrogate is also paid in lakhs by the end of the term. She adds, “The money helps these poor women immensely. Most often, they don’t have anywhere to go to earn for their family’s survival and this is the only way.”
About the ban, she says, “If a Bill needs to be passed, I would suggest let the authorities regulate the laws instead of banning commercial surrogacy altogether. Banning only shows our lack of flexibility. They can scrutinise our procedures, but to forbid it is unhelpful. Where do couples who have been trying for a decade to have their own child goIJ How many close relatives will actually volunteer to be surrogates for themIJ Give birth to their child, take no money, give it away to them and then live as its relativeIJ”
Interestingly, most surrogates do not wish to talk about it. While some are intimidated by constant media attention, others are nonchalant and go about their jobs with a professional attitude. Then there are some who form a bond with the baby and long to see it occasionally. But by rule, no interaction is allowed between the genetic parents and the surrogates. Is the plight of the surrogate mother overly romanticised as many fertility clinics would reason or is ignorance taking an irreparable toll on her health as the Bill arguesIJ
Outsourcing the womb does sound distanced from nature or our understanding of the same. But is this issue an ideological battle or a scientific oneIJ Dirt-poor villagers look at it as a source of income, childless couples who can afford it deem it a logical boon, while society places it on the dock and passes judgements. In this mayhem, can our legal patterns and cultural practices meet each other halfway so that it eventually benefits all parties and a child graces this chaotic world with its graceful presenceIJ
The devil’s surrogateIJ
Big Pharma has constantly sought to colonise the woman’s body in the name of surrogacy, Pinki Virani explains to ANANYA BORGOHAIN
You write about how after the one-child norm was lifted in China, the womb wars expanded.
Big Pharma, as detailed in the opening chapters of Politics Of The Womb: The Perils of IVF, Surrogacy & Modified Babies, has constantly sought to colonise the woman’s body. Add to this where she is at her most vulnerable — her uterus — and the fertility drugs and implements sector within Big Pharma goes straight for her jugular; it taunts her for being “childless” or “birthing only one”. Big Pharma needs big markets and what better than to target large countries like China and India where the woman is so imprisoned by the patriarchal notion of reproduction, that for her to be childfree is to be blasphemous.
Big Pharma works through certain kinds of doctors, who enjoy disproportionate status because of how successfully they can manipulate a reluctant or tired uterus into its first or yet another manufacture — even if it is underweight and ill, as artificial reproduction offspring can also be. The woman as the child’s genetic mother (she has given the egg or oocyte) is so locked into her own fear of being anything other than being perceived as a mother that she is even blinded to the fact that she is hurting another child’s biological mother (genetic mother plus the all-important act of carrying and delivering her own child as its birth-mother) who is also her genetic child’s birth-mother in surrogacy, be it commercial or altruistic.
You say that the Chinese are hiring American surrogates. Do we see similar implications in India now that the Surrogacy Bill 2016 bans commercial surrogacyIJ
There are very few States in America which allow commercial surrogacy. Some Chinese who can afford it — and others like rich homosexuals from countries, for example Australia, which do not allow them to avail of surrogacy — are going there as much for the perk: American citizenship for the child since its birth-mother is one. But there is growing disquiet over this and it is beginning to be voiced by Americans. Canadians are also beginning to voice their concerns; Canada allows only altruistic surrogacy.
This also means that the genetic parents have to pay very little for medical expenses since Canada has a functioning medical welfare scheme for its citizens. The questions being raised are valid — why should countries permit privatised gain at national loss and public expense as these are from legitimate tax-paying citizensIJ
In India, will it go “underground”IJ What is clear is that commercial surrogacy flourishes when there is an intense greed on two sides: Even more financial greed by a certain kind of “fertility clinic” (there is enough to be made in the endless IVF cycles) and genetic greed by those who are willing to buy a baby, which is being benignly trafficked. How effectively the Central and State Governments crack down upon these two forms of greed — which is also blatant exploitation of a woman’s body — will be the determinant.
Why do the deaths of surrogate mothers not receive attention and due discourseIJ
The genetic mother is hyper-ovulated for her oocytes — which a doctor in my book calls the “caviar” to the sperm’s “popcorn” — which if of “good quality” might also very well enter the market for nefarious reasons. Because a mini-menopause of sorts is created so that the genetic mother’s ovaries can then be hormonally hyped into sprouting many more eggs than the mandatory one every month during a menstrual cycle, many more eggs than necessary are forced into existence. Politics Of The Womb carries the latest study on how extra eggs don’t translate into a “take-home baby”.
The book also has an entire chapter warning women on the very real dangers of hyper-ovulation. Such eggs are mated with sperm in vitro — in “cultures”, the synthetic components of which are now being questioned aloud by scientists for what effect it has on the resultant embryo. Extra embryos are made, one of which might even be funnelled elsewhere, depending upon how “good looking” that embryo is to turn into a foetus post the hormonally glued insertion of it into a uterus. My book gives examples of genetic theft and chicanery in gametes (sperm, egg) and embryos.
Third-party reproduction is then brought into this mix via surrogacy. There are other medicines upon her body — to get it to mimic a readiness for pregnancy, she has regular menstruation and this needs to be force-stopped. Then there are other synthesised hormones, injections, pessaries, all those other drugs, that specially purchased hardware, those in vitro labs with all those gleaming machines which have been paid for. Then there is the IVF package of compulsory no-medical-reason caesarean section which also deprives the child of its right to be breastfed, because the newborn cannot be allowed to “bond” with the surrogate even though she is the birth-mother.
There is so much money to be made in such babynomics; the surrogate is just one cog in those giant wheels of the baby-manufacturing factories. She is merely one of the means to that end. And her husband may have nudged her into it, and her own children are now motherless but her death cannot be the doctor’s fault or the genetic parents’, considering she gave “informed consent”.
Has the issue of assisted reproduction been misrepresented as a progressive option, particularly when celebrities like Aamir Khan, Shah Rukh Khan and Tusshar Kapoor are appreciated for admitting that they used surrogatesIJ
No matter how modern Bollywood may appear, it is stuck in some patriarchal stone age — witness how they place the birth of their sons in the public domain, as if it was some divine conception. The tragedy is that such celebrity repetition leads to the romanticisation of not only third-party reproduction but also assisted reproduction. Neither surrogacy — commercial or altruistic — nor the IVF and ICSI, which are part of artificially assisted reproduction, are without the risks of severe downsides to all concerned: The egg-mother, the birth-mother and above all, that innocent baby who has been forced into this world. Which is why there are countries which have simply abolished surrogacy altogether, both commercial and altruistic. These are advanced, very well-developed countries which prefer to be low-population rather than subject the woman to surrogacy and the child to its consequence; and these are countries which are equally strong on the rights of all, irrespective of their sexual orientation.
Can you elaborate how a baby’s health can be affected by IVF surrogacyIJ
I have written about that unborn, so that it does not have to suffer either from IVF or surrogacy. That combination of IVF plus third-party reproduction carries so many risks for that tiny human, that adults feeling seduced into it for its apparent childbearing choices really need to take a step back to re-evaluate. When I say adults, I do not differentiate; this is inclusive of all who are being forced to feel “infertile”, be they married or live-in couples, single women, or lesbians (for whom there is a special section in the book), and homosexuals, who must understand that they are exploiting a woman.
This is not the making of a choice but making a woman a medical victim in the name of a child. And this is only further reinforcement of the oppressive circumstances in which childbearing decisions are already being made. Being childless is not a disease; “fertility clinics” should be resisted for crowning themselves as an ostensible cure.
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