Surrogacy provides much-needed cash for Indian women and joy for childless Western couples but is it quite that simple? Henry Chu reports
As temp jobs go, Saroj Mehli has landed what she feels is a pretty sweet deal. It's a nine-month gig, no special skills needed, and the only real labour comes at the end - when she gives birth.
If everything goes according to plan, Mehli (32) will deliver a healthy baby early next year. But rather than join her other three children, the newborn will be handed over to a US couple who are unable to bear a child on their own and are hiring Mehli to do it for them.
She'll be paid about $5,000 (slightly more than €4,000) for acting as a surrogate mother, a bonanza that would take her more than six years to earn on her salary as a schoolteacher in a village near here. "I might renovate or add to the house, or spend it on my kids' education or my daughter's wedding," Mehli says.
Beyond the money, she adds, there is the reward of bringing happiness to a childless couple from the US, where such a service would cost them thousands and thousands of dollars more, not to mention the potential legal hassles.
Driven by many of the same factors that have led Western businesses to outsource some of their operations to India in recent years, an increasing number of infertile couples from abroad are coming here in search of women willing, in effect, to rent out their wombs.
The trend is evident to doctors such as Indira Hinduja, perhaps India's most prominent fertility specialist, who receives an inquiry from overseas every other week. It can also be detected on the internet, where a young Indian woman recently posted an ad on a help-wanted website offering to carry a child for an expatriate husband and wife.
Then there is the dramatic example of Mehli's family. Two of her sisters have already served as surrogates - one of them for foreigners - and so has a sister-in-law. Mehli finally decided to join in, with the enthusiastic consent of her husband, a barber, and the guidance of a local physician who has become a minor celebrity after arranging more than a dozen surrogacies in the past two years, for both Indian and non-Indian couples.
For some, the practice is a logical extension of India's fast-paced economic growth and liberalisation of the past 15 years, a perfect meeting of supply and demand in a globalised marketplace.
"It's win-win," said S.K. Nanda, a former health secretary in Gujarat state. "It's a completely capitalistic enterprise. There is nothing unethical about it. If you launched it somewhere like West Bengal or Assam [ both poverty-stricken states] you'd have a lot of takers."
Others aren't so sure about the moral implications, and are worried about the exploitation of poor women and the risks in a land where 100,000 women die every year as a result of pregnancy and childbirth.
Rich couples from the West paying Indian women for the use of their bodies, they say, is distasteful at best, unconscionable at worst.
"You're subjecting the life of that woman who will be a surrogate to some amount of risk," said C.P. Puri, director of the National Institute for Research in Reproductive Health in Mumbai [ formerly Bombay]. "That is where I personally feel it should not become a trade."
Both sides of the debate agree that the fertility business in India, including "reproductive tourism" by foreigners, is potentially enormous. Current figures are difficult to pin down, but the Indian Council of Medical Research estimates that helping residents and visitors beget children could bloom into a nearly $6 billion-a-year industry.
"It's definitely going to increase with education and literacy, especially in a country like India," said Gautam Allahbadia, a fertility specialist in Mumbai who recently helped a Singaporean couple find an Indian surrogate. He has received similar inquiries from the US, Israel and Spain.
In the vanguard of the nascent industry is this small city, where gynaecologist Nayna H. Patel is presiding over a mini baby boom. But eight of her recent and imminent arrivals won't be adding to Anand's population of 100,000.
Three of the infants are destined for the US, two for Britain and three for other parts of India. Six more surrogacy attempts were unsuccessful.
Before Patel's practice began attracting national and international notice, Anand was famous for decades as the milk capital of India, home to the country's most successful dairy farmer co-operative.
Now the town also boasts about 20 young women who have volunteered to be implanted with embryos at Patel's clinic. A few have already gone through the process once and are eager for a second turn.
Prospective foreign clients hear of Patel through word of mouth or informal online networks and websites dealing with infertility issues. By the time they contact her, and spend the time, energy and money to get here, they are usually desperate for children and often emotionally battered from long years of trying and failing.
Patel has set some criteria for those she'll help: only couples for whom the baby would be their first and where the wife is either infertile or cannot physically carry her own child to term.
Likewise, potential surrogates must be between 18 and 45, in good health, and mothers in their own right, for physical and psychological reasons - physical, so that they know what awaits their bodies, and psychological, so that they feel less troubled about giving up the new baby because they already have kids at home.
The egg that contributes to the embryo is never one of their own, coming instead from an anonymous donor or the intended mother, and then usually fertilised in vitro.
Both parties sign a contract under which the intended parents pay for medical care and the surrogate renounces rights to the baby, a provision that relieves the fears of many foreign couples. In the US, for example, where laws vary from state to state, the surrogate sometimes has a window of opportunity after birth to stake a claim on the child.
In Anand, volunteers are repeatedly reminded by Patel and her staff that the foetuses in their wombs are not theirs. They give up the newborns within one to two days after delivering. Patel says no problems have arisen yet with too strong a bond forming between surrogate and child.
She acknowledges that money is the primary reason these women have queued up to be surrogates; without it, the list would be short, if not non-existent. Payment usually ranges from about $2,800 to $5,600, a fortune in a country where annual per capita income hovers around $500.
But Patel cites cultural components as well - an empathy with the childless here in a society that views producing progeny as an almost sacred obligation, and Hindu teachings about being rewarded in the next life for good deeds performed in this one.
"Those couples who don't have kids long for them, and I can understand their feelings," says Smita Pandy (27) who has two children of her own and is about to give birth on behalf of another Indian couple.
"I'll be happy because they'll be blessed with a child."