Surrogacy tourism to rise

India is emerging as the hottest destination for surrogacy says Kamini Rao, fertility expert and member of the national advisory committee on Assisted Reproductive Technology (ART). She speaks to Nature India about the proposed law to regulate this technology.

K. S. Jayaraman

doi:10.1038/nindia.2012.41 Published online 26 March 2012

Kamini Rao

© Kamini rao

Q. What is surrogacy?

A. The desire to procreate is a central attribute of the human race. But some are denied the joy of parenthood for several reasons. Surrogacy is a way of creating a genetic progeny for them. It is an arrangement in which a woman — the surrogate mother — carries and delivers a child for a couple who cannot have a child any other way. Surrogacy forms a small part of Assisted Reproductive Technology or ART. Only about 5% of the infertile population may require this service. Surrogacy is not new and is mentioned since the biblical times.

Q. What is the extent of prevalence of surrogacy in India?

A. Exact figures are not available as neither ART clinics nor ART agencies — which recruit surrogate mothers — are required to release the information. But, I guess, there have been around 2000 surrogate births all over the country so far. There are some 800 ART clinics in India but only a few offer this service.

Q. Why is it in demand?

A. Decreasing number of children available for adoption is one reason why surrogacy is in demand. Increasing number of people, including celebrities across the globe, opt for surrogacy services. Recently, Bollywood couple Amir Khan and Kiran Rao became parents of a baby boy through the help of a surrogate mother. To name the others, Sarah Jessica Parker and Matthew Broderick, Kelsey Grammar, Dennis Quaid, and Ricky Martin have all become parents with the help of a gestational surrogate mother.

Q. And the ethics of surrogacy?

A. There is nothing wrong or unethical about it as long as the Indian Council of Medical Research (ICMR) guidelines — that will soon become an Act — are not violated. Unlike kidney donation, where the organ is removed and gone, a surrogate mother is only renting her womb to carry someone else's baby. The womb is intact and she can have babies of her own. It is like blood donation — the blood gets replenished and the person can donate blood again. The surrogate mother only provides a service. She gets paid for the trouble and the infertile couple get babies.

Q. Is surrogacy getting commercialised? Are poor women exploited?

A. I cannot say it is all commercial and I do not think poverty is driving women to rent their wombs. Many women come forward because they want to help the infertile couple as a humanitarian service. At the same time they need to be compensated for medical expenses, time lost at work, and wear and tear of their body. The compensation can be anywhere from Rs. 50,000 to a million. That is something settled among the surrogate mother, the commissioning couple, and the ART agency recruiting the surrogate. The ART clinics, responsible only for the medical aspect of surrogacy, do not come into picture.

Q. How about surrogacy tourism?

A. Not all countries allow surrogacy. Therefore, cross border reproduction care is on the rise, with India being one of the most sought after destinations for fertility tourism. Currently about 10% of surrogacies are commissioned by persons from outside India, mostly non-resident Indians. The number is likely to grow once the legislation is in place.

Q. What is the need for legislation?

A. As of today, anyone can open an infertility or ART clinic. Such clinics are mushrooming across the country. It has become important to regulate their functioning to ensure that the services provided are ethical and that the rights of all those concerned are protected.

Q. What will the legislation ensure?

A. Couples have to obtain the service of a surrogate only through registered ART agencies. Only women in the age group of 21-35 shall be eligible to act as surrogates. In the case of a relative acting as a surrogate, she should belong to the same generation as the woman desiring the surrogate. Only Indian citizens shall have a right to act as a surrogate, and no ART agency or ART clinic shall receive or send an Indian for surrogacy abroad. Any exploitation of the surrogate mother or the commissioning couple will invite strong punishment. Having emerged as the hottest destination for surrogacy, it is but natural for India to take the lead in evolving a law that safeguards the interests of all the parties concerned. We are all keen to get the legislation through.

Q. What does the legislation say about surrogacy tourism?

A. Foreign couples seeking surrogacy in India shall appoint a local guardian legally responsible for taking care of the surrogate during and after the pregnancy. Also the issue concerning birth certificate and nationality of the child born through surrogacy needs to be addressed when the commissioning parents are foreigners. Foreigners or NRIs seeking to rent a womb in India have to give evidence that their country of residence allowed surrogacy and would give citizenship to a child born through the surrogacy agreement.