Parvati Lal Bahadur Yep is eight months pregnant with twins. Dressed in a pink and white maternity gown the 30-year-old gently caresses her distended belly as she paces the sparsely decorated room of a house in Ahmedabad, in the western Indian state of Gujarat.
Parvati is trying hard not to get too emotionally attached to the babies kicking inside her. She knows she’ll be giving them away less than an hour after they are born to a couple from South Africa she’s met just once. After all, they have paid her around Rs300,000 (Dh20,000) to carry the babies for them – an unimaginably huge amount compared to the Rs7,000 (Dh464) per month that her husband earns as a driver.
“I have my family – my three beautiful children – I don’t want any more. I’m not getting attached to these babies as I’ll be giving them away,’’ says Parvati, trying hard to mask the emotional bonds she fears she’ll develop with the unborn babies in the course of her ‘job’.
What has made Parvati sign up with an infertility clinic in Ahmedabad and give up nine months of her life with her family to stay in the home along with 60 other surrogate mothers is very clear – the money that she will get.
“What my husband earns is barely enough to buy food to feed our three children,’’ Parvati says. “So when my neighbour told me about earning a huge amount of money as a surrogate I got in touch with an agent who put me in touch with a clinic.’’
The clinic Parvati works for – Akanksha Infertility Clinic – has two houses full of pregnant women and it is not the only one in India. There are an estimated 1,000 such clinics in Hyderabad, Delhi, Mumbai and Ahmedabad. Dubbed ‘baby factories’ they have been responsible for as many as 2,000 surrogate births for women overseas last year.
Dr Kamini Patel, the director of Vani IVF Centre, in Ahmedabad, has delivered 48 surrogate babies since she opened the centre nine years ago. “These women live very challenging lives. Being a surrogate has transformed them, and in my opinion, they’re doing great work,” she says.
In 2002 India legalised commercial surrogacy and since then the industry has boomed, making the country a lucrative medical tourism destination. Of the estimated 2,000 surrogate births in India, the majority are in Gujarat. The state has become known as the surrogacy capital of India because it is cheaper, has clear laws and possibly because Akanksha’s director and founder Dr Nayna Patel appeared on the Oprah Winfrey Show in 2007 to talk about surrogacy. The Confederation of Indian Industry, a non-profit organisation that closely works with the government on policy issues, predicts that this year surrogacy will generate $2.3 billion (Dh8.4 billion).
Couples fly to India from the UK and the US hoping to realise their dream of having a baby by taking advantage of the legal and more affordable surrogacy industry there.
But Westerners are not the only ones making a beeline to the fertility clinics. Many infertile couples in India, too, are turning to their country’s surrogates. Bollywood star Aamir Khan and his wife Kiran Rao are two of the high-profile celebrities who have had a baby through surrogacy.
Some couples need an egg donor, while others need a womb as a ‘vessel’ to house their embryos. One thing that is certain, the couples who need a donor or a surrogate live a very different life and come from very different economic circumstances than the surrogates who often live in an impoverished village or slum struggling to make ends meet.
The cost of surrogacy in the US is approximately $160,000 (Dh587,697), but in India it costs a couple between Dh82,000 and Dh118,000 for a surrogate – depending which clinic they choose and how plush they want their stay in India to be. The surrogate gets between Dh17,000 and Dh30,000 and the rest of the money goes to the clinic to cover medical expenses and accommodation for the surrogate.
While most couples dip into their savings to afford the fees, the money the surrogates earn allow them to buy a house, send their own children to a good school and secure a financial future they never dreamed of before. The clinics produce safe and binding contractual agreements with each surrogate that makes it impossible for any loopholes to emerge – as is common with surrogacy in the UK. The strict laws also mean there is very little possibility that the surrogate will fail to hand over the baby as sometimes happens in the UK and the US. Experts say the watertight contracts are one reason India has become so popular and trusted for surrogate births.
Legal and medical protection
The Indian Council of Medical Research (ICMR) has set national guidelines to regulate the industry, and Indian law states the surrogates must sign away her legal rights to the baby as soon as it is born.
To better regulate this growing industry, India’s Health Ministry recently drafted the country’s first surrogacy laws, which set age limits and the frequency with which surrogates can give birth. A woman must be over 21 but less than 35 years old and cannot have delivered more than five times.
Each surrogate can only ‘rent’ their womb up to three times. India’s law prohibits them from doing it any more in order to protect their health. But often, the women give birth to twins or even triplets - up to three times.
However, surrogacy has not been without its pitfalls and dangers. In May, Premila Vaghela, 30, a surrogate for an American couple, died due to complications when she was eight months pregnant. The child was delivered by C-section after Premila collapsed and is doing well.
The process of becoming a surrogate is not easy. The candidates are medically and psychologically tested before they’re given the all clear, says Dr Kamini. The clinics also check if the women already have children so they know whether or not they are familiar with child bearing and delivery. One of the conditions to become a surrogate is that the woman should have delivered at least one child. Most surrogates choose to leave their families for nine months in a bid to keep their actions a secret from in-laws and other relatives.
In Parvati’s case, no one other than her husband and mother know that she is having another couple’s baby. For her, It is imperative that it is kept a secret as her in-laws and some people in her community believe surrogacy is a form of infidelity.
“Even though I have no doubts about what I am doing, I would rather keep it private,’’ she says. “I don’t want people to think badly of me in my community for leaving my family for nine months. I don’t want to take the risk.’’
To prevent too many questions from being asked by neighbours or relatives about her absence, the usual excuse a surrogate offers is that she is going to spend some time at her maternal home due to a medical condition or an ill family member.
Every Sunday the surrogates are allowed visitors, which is when their husbands and children bring them items they have missed from home such as family photos, a favourite dress or even a favourite dish of food. But the couples who hire the surrogate do not visit. “We do not encourage the couples to connect directly with the surrogates to eliminate any possibility of blackmailing,’’ says Dr Kamini.
When Parvati met the couple she is having her surrogate twins for, she was transparent about her reasons for doing this. “They asked me what I would do with the money and I told them about my financial situation,’’ she says. “I also told them that I needed it to give my children a better life.’’ The rooms in the house where the surrogates stay are neat and clean, but bare. There is a TV and a music system, and most evenings the women watch popular soaps.
Around 25 pregnant women stay in each house, and typically there are about five women per room. Keeping all the women in one place suits the clinics as the women can be monitored. Doctors and nurses can make sure they are taking all their vitamins, eating well and having the right ultrasounds. It also means blood tests and blood pressure readings can be taken as often as required.
There is unity between the women. They all know they are there to do a job. They support one another and when one is due to give birth the others rally around her.
Each house has a master nurse who cares for the surrogates and makes sure they are medically taken care of and emotionally supported throughout the process. The nurse is trained and qualified and is very often someone who has retired from a government hospital in India. She is very experienced in helping pregnant women.
No cooking is done in the house. Instead, a dabba walla (lunchbox delivery boy) delivers a traditional Indian tiffin box, a three-tiered food container, at meal times and the women all sit and eat together.
The food is simple but well balanced and nutritious. “We ensure that all her and the baby’s nutritional and medical needs are met,’’ says Dr Kamini.
The beds are simple, and each room has a fan but no air conditioning, even when temperatures hit 40 degrees. But compared to their own huts in slums, that often lack even the most basic facilities, the house the surrogates stay in is palatial.
Fees for the surrogates – who are never told the sex of the foetus they’re carrying – depend on whether they carry a single baby, twins or triplets. The women say they still receive partial payment if they miscarry or if scans detect a problem that results in the termination of the pregnancy – a procedure they have no say over. How much they get depends on how many months along they are. “Yes it would be nice to get paid more… we all want more money. But I want to be here doing this,’’ says Parvati.
She doesn’t think the women are misled or tricked into becoming surrogates – they volunteer knowing the financial benefit their family will receive.
Although there are agents who liaise between the women and the centres, she says once they arrive at the hospital they are given a comprehensive explanation of what to expect from the process and what is expected of them in return.
“We have all got involved in surrogacy willingly. We know what we are doing,’’ Parvati insists. “I’m sure people overseas live very good lives but this is my life and I want to make the best of it. I’m glad surrogacy exists because it’s an option for me to make more money. I’m thankful for that.’’
Although they are doing it for the financial benefits, many women find it difficult to cut the emotional cord that develops during the nine months they carry the baby.
Manuben, a surrogate at Akanksha says: “I had to programme myself not to build any emotional links with the baby. I had to keep thinking this is not my baby and that I am here only to do a job. Each job has a requirement and this is the requirement of being a surrogate, I guess.’’
Thirty-five-year-old Jaya Ben Raval from Nadiad in Gujarat is married with two children. She is seven months pregnant. “I do have an emotional bond with the baby I am carrying,’’ she admits, stroking her bump.
“Of course you get a little attached to the baby growing inside of you and it’s a little hard at the end, but it has to be ended when you deliver.’’
Parvati nods her head in agreement: “As soon as the baby is born I know I’ll think about it for a while, but my love for my own children will be more powerful. In the end, giving birth to this child means I’ll finally be reunited with my own. I don’t know anyone who has regrets.”
The clinics do all they can to ensure there is little bonding between surrogates and the babies they are carrying.
“The baby remains with the surrogate for just an hour before it’s handed over to the couple. The surrogates most definitely do not breast feed – to prevent bonding. There are some clinics that don’t allow them to meet the baby at all,” explains Dr Kamini.
The women leave the hospital as soon as they are able to take care of themselves. In the case of complications, the centre takes care of them offering all the medical help they need. The women are allowed to pay for their treatment in instalments.
Many of the clinics take care of the women even after they have finished working for them. The Akanksha Infertility Clinic has formed the Anand Surrogate Trust, which helps the surrogates after they deliver. A group of women help the surrogates with any emotional or psychological issues they have following the birth. They also help her own children to get a better education and become involved in extracurricular activities at centres across
Akanksha’s founder Dr Nayna believes that surrogacy is a win-win situation for all – something many Indian doctors agree with. The doctors also believe that it is in the interest of clinics to take good care of the women involved in commercial surrogacy.
The surrogates are happy to bring a smile to the faces of childless couples desperate for a child. “I am helping a woman fulfil her dreams while she is helping me provide a better life for my own children. It works both ways.’’ Parvati says.
Manuben says: “The money I get from being a surrogate mother has earned me respect and freedom.’’ Jaya who is sitting on the nearby bed, agrees: “We are choosing to do this so we can better our lives. Is that a bad thing?’’
*names have been changed to protect identities.