Everyone forgets the surrogate

Brinda Karat

17 Jul 2012

Government must bring the assisted reproductive technologies bill to Parliament. More stringent regulation could have saved lives

Sushma Pandey,just 17 years old,reportedly died due to procedures related to egg harvesting conducted on her by a fertility clinic in Mumbai. Two years after her death,the Bombay high court did well to criticise the police for not prosecuting the hospital for its flagrant violation of the age requirement for women donors set out by the rules of the Indian Council of Medical Research. (Indian Express,July 12) Sushma is not here to tell us the circumstances that drove a minor to subject herself to highly invasive procedures of egg harvesting — not once,but three times — in a short span,on payment,reportedly,of Rs 25,000 each time. But her case does raise a range of issues,such as the use and misuse of assisted reproductive technologies (ART) in India by the fertility industry,a major part of which caters to a foreign clientele.

The protest of women’s organisations against the current practices of the fertility industry have nothing in common with the opposition of orthodox groups who are against the use of technology per se as it “interferes in God’s work and will.” The ethical,legal and social questions are related to the commodification and commercialisation of not only a woman’s reproductive tissues but also her womb,in what is referred to as “rent-a-womb” in surrogacy commercial ventures. There are also questions of whether this high-profile industry is strengthening stereotypical notions of the importance of “making my own baby”,as opposed to adoption as an alternative for couples wanting to have children.

For a woman to become an egg donor is not without risks. She is given hormonal drugs to stimulate her ovaries,daily injections for 10 days or more. An advertisement by a well-known fertility clinic that they can produce “an egg donor being super ovulated just for you” illustrates that the crass driving factor is not the health of the egg donor,but to convince the commissioning couple that their interests are being protected. Super ovulated egg donors can be expected to produce a larger number of eggs on the demand of the expectant couple. There are other conditions too. Indian newspapers and websites carry ads much like the matrimonial ones. Don’t be surprised by ads like the one in a women’s magazine that said,“Wanted: a fair,good-looking,educated,healthy lady,preferably a Brahmin of 20-30 years of age in Chennai with good background for egg donation.” Critics have referred to this as the designer-baby syndrome,but a more serious question is the kind of genetic-supremacist values that get promoted. Isn’t it true that there is only a thin dividing line between the use of ART to “choose” to produce only fair,light-haired babies through the “right” egg or sperm donor and the ideologies of racist supremacy that the world is all too familiar with?

Such troubling issues are even more pronounced in the case of surrogacy. Say a woman has healthy eggs but cannot carry a baby to its full term. Her egg could be fertilised with her partner’s sperm through in-vitro fertilisation (IVF) and then implanted in the womb of a “surrogate mother” without affecting the genetic make-up of the embryo. The surrogate carries the baby to its full term and hands the baby to the “biological parents”. The cost for a surrogate and the entire procedure in India is one-third that in North America or Europe,which makes India the favourite destination of the reproductive tourist industry. There is ample documentation about surrogate mothers,who are mainly from poor backgrounds or driven by circumstances,including unemployment,domestic distress,etc,who offer their wombs on commercial terms. Once the baby is born and delivered,the surrogate mother is forgotten,the implications on her health and mind are of no concern. The tragic death in Ahmedabad in May of Premila Vaghela,a 30-year-old surrogate in the eighth month of her pregnancy,was reported in a leading national daily in words to the effect that “Premila died,but she performed her duty… the baby is safe in the arms of its biological parents.” Just as in the case of the egg donor,in the case of surrogacy too,it is not the health and well-being of the surrogate,but the safe delivery of the baby that is of prime concern.

Ethical considerations of using a woman’s social and economic vulnerability to commercially exploit her womb as a commodity to make handsome profits is of little consequence to the promoters of the fertility industry. The physical stress,risks,emotional and physical trauma,and then the abrupt separation from the baby carried in the womb for nine months are immaterial. It is said that the surrogate is asserting her independent agency to make choices to better her life and those of her family. But what does “choice” mean when she did not choose to be poor,she did not choose to be unemployed,she did not choose to live in a country where children die of starvation? When poverty is not a choice,then to call desperate survival strategies that women adopt an expression of women’s agency is to make a mockery of the very concept.

The Indian government has acted in the most irresponsible and callous manner by ignoring these questions and by permitting the fertility industry to do what it pleases. There is no law to regulate the industry in India. Surrogacy is banned in France,Germany,Italy,Spain,Japan and Switzerland. Commercial surrogacy is banned in New York and several other states in America,the UK,Canada,South Africa and Australia. These countries allow what is called altruistic surrogacy. But the draft bill in India dealing with the use of ART is in cold storage since 2008. There are many problems with the bill but,in spite of it being in the public domain,there has not been much interest except from women’s organisations. Should there be a ban on commercial surrogacy? Or will a ban drive the practice underground,increasing the vulnerability of surrogates? Should foreign citizens who are banned from using surrogates in their own countries be allowed to use poor Indian women as surrogates? These questions and others need wider discussion but as an immediate measure,it is essential for the government to end the inordinate delay in bringing the ART bill to Parliament. Sushma,Premila and other victims may have been alive today had there been more stringent regulation.

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