Surrogacy in India vs. Surrogacy in the United States

It seems that surrogacy in India is growing faster than Starbucks franchises, with a clinic on every corner in both major cities and small villages alike. There are approximately 1000 surrogacy centers in India and, according to a recent article in Mother Jones, surrogacy is rocketing toward a reported 2.3 billion dollar business in 2012. Each year, it is estimated that 25,000 foreign couples come to India for surrogacy services, resulting in over 2,000 births.

I have been collecting articles on surrogacy in India and one thing I’ve noticed is that most of the articles in favor of surrogacy in India come from sources that benefit financially from this business. Having worked with intended parents for close to 16 years, I am well aware of the huge cost involved in surrogacy. I also understand that for many intended parents, this cost can make it impossible to use a surrogate, which may be the only way they can have a child that is genetically related to one or both parents. Because of this, I can see why many couples flock to India to have the child of their dreams at a more affordable price. But should we really be using the words "cheap" and "surrogacy" in the same sentence? After all, carrying a child for someone is a noble and priceless act of altruism, regardless of the compensation. That statement may seem like a contradiction unless you take into consideration the fact that childbirth, even in present day, can be life threatening.

There are several major differences between surrogacy in the United States and in India.  In the United States, women who live below the poverty level are not eligible to become surrogates, the reason being, if not for financial need, a woman may not choose to become a surrogate. In India, which is often considered a male-dominated society, particularly among the poor and uneducated class, women in extreme poverty are often encouraged to become surrogates as a way out of financial hardship. The majority of Indian surrogates come from this socioeconomic class, so when one's husband sees an ad for women to become surrogates, the wife may be hard pressed to say no. Dr. Nayna Patel, one of the leading players in the “baby factory” states, “How can you say that couple is exploiting the female when that female willingly wants to do it?” My answer is that these women feel they have no other option, which is the very definition of exploitation. We want to make sure that the women who choose to become surrogates are making the choice not for purely monetary reasons but because they want to help someone else experience parenthood. They should of course be fairly compensated for the risk and be treated with the utmost respect throughout the process.

Women all over the world today still die in childbirth, and unfortunately, that is what happened to a young woman named Easwari. Her husband insisted that she become a surrogate to supplement the family’s income. When she started hemorrhaging after the surrogate birth, her husband was told by the clinic that they could not help her and that he would need to pay for an ambulance to transport her to a hospital. Easwari died en route.  In another tragic case much like Easwari’s, Premila Vaghela, another Indian surrogate who was in her eighth month of pregnancy, had a seizure and died while waiting for a routine medical exam. Very little was made of her death since the baby survived. ( “In fact, Premila was like many other economically marginalized surrogates, who may suffer or even lose their lives while carrying a child, and are quickly forgotten.”

Dr. Nayna Patel states on Australia’s Dateline that there are more surrogacies taking place in the United States than in India, yet no one is saying that American surrogates are being exploited, so why is it we believe Indian women are being exploited (click the link for the full story.) I will tell you why. Here in the United States, a surrogate can be compensated for being a gestational carrier; she is not just financially compensated for her time and suffering, she is also treated humanely. She is not forced to live in a dorm away from her family, as is often the case for surrogates in India. This is a practice done not only to guarantee that the surrogate is eating properly and to monitor her progress, but also because she would be ostracized if she were carrying a surrogate pregnancy in her own village. “We found some disturbing trends. For instance, though the husbands do not mind their wives to act as surrogate mothers, the spouse and her children distance themselves from her after she returns home following the birth of the baby,” CSR director Dr. Ranjana Kumari said. In Anand, around 52 percent of the surrogate mothers said their husbands abandoned them and that most of them had to fend for themselves and their children. 

Typical Indian contracts for surrogates requires the surrogate to agree that even if they are seriously injured during the later stages of pregnancy, or suffer any life-threatening illness, they will be "sustained with life-support equipment" to protect the fetus. Further, they usually agree to assume all medical, financial and psychological risks – releasing the genetic parents, their lawyers, the doctors and all other professionals from all liabilities.  

In contrast, American contracts are written to protect both the surrogate and the intended parents. The American surrogate lives at home with her family. In most cases, a caseworker has been to the surrogate’s home to make sure she lives in a safe area and that the home is clean, and that her children are well cared for. Both the surrogate and her husband must pass a psychological evaluation, a background check, and they cannot be on any type of public assistance. This last issue is important because we want to ensure that the surrogate is not in a financial position where she feels she has no other choice than to ‘rent her womb,’ which is the common terminology used regarding surrogacy in India.

For the Indian surrogate, it is a one-sided, isolating experience and in most cases, the surrogate will never meet the intended parents she has helped.  In fact, the surrogates are discouraged from having any interaction with the intended parents. Not only is the surrogate separated from her family and society in a dormitory with other surrogates, she never gets to experience the joy of handing over the couple's baby and seeing their faces when they see their child for the first time. American surrogates, and even the husbands of American surrogates, have told me that this is what being a surrogate is all about: sharing that moment of joy and knowing you have given life to this couple's dream. The relationship between surrogates and intended parents in the U.S. is interactive throughout the whole process. In America, intended parents meet their surrogate prior to any contracts being signed; it is a mutual decision to work together. Both the intended parents and the surrogate must feel that it is a good fit, and that they will have a supportive relationship from the first meeting through the birth and often beyond. It is not unusual for parents and surrogates to remain in touch after the birth of their child. What fuels many surrogates' desire to be a surrogate is the joy that they can bring to someone who cannot carry a pregnancy. Most surrogates are financially compensated in the U.S., but frankly, whatever they are paid comes down to pennies if you break it down into everything a surrogate must do to help someone have a child. Pregnancy takes a huge toll on one's body and childbirth is still a risky business. Even in the U.S. a woman may still die in childbirth, which is why intended parents are required to purchase life insurance for their surrogate. The surrogate's family will be the recipients of the that life insurance policy so if something should happen during the pregnancy or birth, the surrogate’s family will be compensated and taken care of. This is in sharp contrast to practice in India where the surrogate’s family has no recourse beyond the surrogate fee, should the surrogate die during the course of her surrogate pregnancy.

I can’t fault intended parents for turning to India, as I know they are desperate for a child. The intended parents are being sold on the idea that somehow they are helping these Indian surrogates by compensating them with this meager fee; after all, it could take a poor Indian family approximately 15 years to earn that much money. But the medical professionals who have entwined themselves in this business are a completely different story. They are benefiting from the desperation of two diverse populations who are driven by two very powerful forces: an escape from poverty on one side of the equation and the desire for a child to call their own on the other.

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