Why Some Of India's Surrogate Moms Are Full Of Regret

Sep 18, 2016
Originally published on September 20, 2016 7:12 pm

Isha Devi hails from Agra, home of the Taj Mahal, built by a grieving king for a beloved queen. Isha now lives three hours and a world away from any such romantic ideals.

Renting a small dingy room, this mother of a 12- and 14-year-old has come to the outskirts of New Delhi to live close to her fertility clinic. Isha, 30, is six months pregnant with someone else's twins. Her room opens onto a noisy alleyway of families in similarly cramped quarters all sharing a single bathroom. Isha groans, shifts uncomfortably on her cot and rearranges her pink floral sari.

Isha explains, "I was helpless" and became a surrogate to expunge a family debt.

Surrogacy has been described as a thriving — and lucrative — industry in India. But no national surveys have been done to come up with an estimate of how many women are involved. And no law currently governs surrogacy in India.

That could change. The government is proposing a law that would bar couples married fewer than five years, unmarried couples, gays, singles and foreigners from commissioning a surrogate. "Legally wedded couples who have been married for at least five years can opt for surrogacy," the foreign secretary has said about the proposed legislation. The bill would limit the practice to "altruistic" cases, where a woman would provide the services of her womb for free, either for implantation of an embryo conceived by in vitro fertilization or artificial insemination with the father's sperm.

But with India's most disadvantaged women acting as surrogates, would a ban deprive them of an economic opportunity or protect them from exploitation?

"I would have never done this," Isha says. "But my husband had a terrible accident when his rickshaw slid under a bus. He fractured his hip and can't work. That was our only income." Her husband earned $5 a day. His medical bills mounted to $3,000 dollars.

Then her sister told her that women get paid for carrying a child. Isha earns $160 a month during the pregnancy and will receive a lump sum of about $4,200 after the birth. But she says the monthly stipend is too small to pay off the debt, support her family, pay the rent and buy the pricey fruits and vegetables her doctors recommend she eat to stay healthy during the pregnancy. She does get free vitamin supplements from the clinic.

Petite and noticeably pregnant, Isha says she's often hungry.

Her doctor, embryologist Anoop Gupta, runs one of the largest fertility clinics in New Delhi.

Judging by the constant telephone interruptions during the course of our interview, he's a man in demand. His clients, who span the globe, are mostly couples using in vitro fertilization to conceive their own child. Gupta's surrogacy practice is small. Gupta says he started working with surrogates in 1997 and has "650 surrogacies delivered by now."

His clientele includes gay couples and single females, a growing part of the surrogacy picture in India. "You are helping people who are helpless," he says.

Gupta says the going fee is one million rupees — or $14,000. Surrogates, such as Isha, receive less than half of the money. Doctors, agents, lawyers, labs, and technicians all get a cut. Still Gupta considers surrogates well-compensated and dismisses criticism that India's poorest women are being taken advantage of. "Pregnancy is not a big deal for them," says Gupta, who adds that he looks for "simple" women and once selected an educated engineer who gave him nothing but "headaches."

"Even if they don't [participate in] surrogacy, they will get pregnant themselves," he says of the impoverished women who become surrogates. "They do not use contraception. So they get pregnant, pregnant, pregnant! That's it! They are thoughtless people. Now if they get an opportunity to help somebody who is childless, and they help themselves with the money they can never think of in their lifetime — nobody has been exploited." In his view, the surrogates are helping alleviate their poverty and are less of burden on the state. "So what is wrong with that?" he asks.

Manasi Mishra, who heads the Research Division at the Centre for Social Research in New Delhi, thinks there's plenty wrong with it. She says the industry is "run by haves, to exploit the have-nots." She says Indian surrogates are rarely in a position to change the fundamental circumstance of their poverty because the payments simply aren't enough.

"This pregnancy is precious," Mishra asserts, "the mother is not."

In studies of 200 surrogates conducted in 2010 and in 2012, Mishra found many weren't paid what they were promised and deceived about the procedures. She says many women are told their deliveries will be natural childbirth but often undergo a Cesarean section. She also discovered some couples had commissioned more than one surrogate to boost their chances — with the less viable fetuses eliminated through a pill-induced miscarriage. "When she goes for a check-up, she's given the pill and told to come back after lunch," Mishra says, and then returns bleeding.

"She doesn't know it is an induced abortion," says Mishra. "She has been made to believe that it is because of her carelessness that she has aborted." One woman told Mishra she wasn't paid anything after losing the baby.

Mishra says one doctor "had the audacity to tell me that in a country where we have a high fertility rate" and where women abort unwanted pregnancies, where is the harm in "surrogacy arrangements?"

"We cannot do that in a civilized society," she says.

Jayashree Wad agrees. Last year, the 78-year-old attorney filed public interest litigation against surrogacy in a bid to bring to the attention of the Supreme Court the fact that the industry is "unregulated" and "abundant."

Wad argues that surrogacy amounts to the "commercialization of motherhood" and that it constitutes a form of exploitation using the bodies of women she describes as "downtrodden." She argues that the practice is an "infringement of fundamental rights" guaranteed under the Indian Constitution, specifically "unknowing exploitation."

Mishra says Indian surrogates typically have no more than a fifth grade education. They often cannot read contracts drafted in English. The surrogacy process makes a mockery of consent, she says.

Karuna Nundy, an attorney who practices before the Supreme Court, says the person "hiring the lawyer" typically gets to frame the terms — but "informed consent is absolutely essential."

Nundy says surrogates routinely do not understand their payment schedule or what health care services are being provided or the risks of surrogacy.

"The kind of information that is lacking, is what does this contract really mean? What do I do if all of these promises aren't panning out the way that you promise they are?"

Some observers believe a government committee needs to hear from the women whose bodies are being rented in the first place before any decision is made whether to ban or regulate surrogacy.

"So if you have a bunch of commercial surrogates who are saying we need a ban, you have a ban," Nandy says. "If you have a bunch of commercial surrogates who say, 'No, I want to do this, but it's not fair, I need more money,' then that points to a regulated industry."

Nundy adds that if we ask disempowered women what they want, "We start to think of them as whole people, we start to ask them what they want as citizens."

Back in her room, Isha Devi says she wants to meet the woman whose twins she is carrying. That's not likely. Doctors discourage it. It's one more uncertainty in a life bundled with them. But Isha has no doubt about one thing.

Surrogacy would not have been an option to enhance her family's meager finances had her husband not fallen ill.

Feeling alone and anxious, Isha quietly says: "Whatever I'm going through, nobody should go through."

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

RACHEL MARTIN, HOST:

Couples who can't conceive a child look for all kinds of alternatives in order to become parents, including surrogacy, when you pay a woman to carry and give birth to your baby. India is preparing to ban this practice altogether. As NPR's Julie McCarthy reports, that move could protect women who serve as surrogates from exploitation, but it could also take an economic toll.

JULIE MCCARTHY, BYLINE: Isha Devi hails from Agra, home of the Taj Mahal, built by a grieving king for a beloved queen. Isha now lives three hours and a world away from any such romantic ideals. Renting a small, dingy room, this mother of a 12- and 14-year-old has come to the outskirts of Delhi to live close to her fertility clinic. Isha is 30 and six months pregnant with someone else's twins. She groans, shifts uncomfortably in her pink floral sari and says she became a surrogate to expunge a family debt.

ISHA DEVI: (Speaking Hindi).

MCCARTHY: "I would never have done this, but my husband had a terrible accident when his rickshaw slid under a bus. He fractured his hip and can't work. That was our only income," she says. Her husband earned $5 a day. His medical bills are $3,000. She is paid $160 a month during the pregnancy with a lump sum after the birth. But Isha says the stipend is too small to pay off the debt and buy the food her doctors recommend she eat. The petite woman with a basketball-size bulge in her stomach says she's often hungry.

ANOOP GUPTA: Good morning. Yeah, you're calling from which place? London.

MCCARTHY: That's Isha's doctor, Anoop Gupta. His clientele is international, mostly couples using IVF to conceive their own child. Gupta's surrogacy practice inside his fertility clinic, one of Delhi's largest, is small. And embryologist Gupta says he performed the first surrogacy in 1997.

So you've been doing this for 19 years.

GUPTA: But it has picked up. Like, last 10 years we are doing quite a bit. See, we have 650 surrogacies delivered by now. And we have a lot of gay couples coming. Then a lot of single females also we have done.

MCCARTHY: No law governs surrogacy in India, but the one the government proposes bars gays, singles, foreigners and Indian couples married under five years from commissioning a surrogate. The bill limits the practice to altruistic cases where a woman would provide the services of her womb for free. Gupta says the going rate today is 1 million rupees, or $14,000. Surrogates such as Isha receive less than half that - doctors, agents, lawyers, labs and technicians all get a cut. Still, Gupta considers such surrogates well-compensated and blanches at criticism that India's poorest women are being taken advantage of.

GUPTA: Even if they don't do surrogacy, they will get pregnant themself. So they get pregnant, pregnant, pregnant - that's it. Now, if they get an opportunity to help somebody who is childless and they help themself with the money which they can never think of in lifetime, nobody has been exploited.

MCCARTHY: Manasi Mishra disagrees and says the industry is, quote, "run by haves to exploit the have-nots."

MANASI MISHRA: And this pregnancy is precious - the mother is not.

MCCARTHY: Mishra is with the Center for Social Research and conducted studies on 200 surrogates in 2010 and 2012. She found many were cheated out of money and deceived about the procedures they must undergo. She also discovered some couples had commissioned more than one surrogate to boost their chances, with the less desirable fetuses eliminated through a pill-induced miscarriage. Mishra says the unwitting surrogate gets blamed.

MISHRA: She doesn't know it is an induced abortion. She has been made to believe that it is because of her carelessness that she has aborted.

MCCARTHY: Mishra says Indian surrogates like Isha typically have no more than a fifth-grade education. They often cannot read contracts drafted in English. It makes a mockery of consent, she says.

KARUNA NUNDY: I think informed consent is something that's absolutely essential.

MCCARTHY: Karuna Nundy is a Supreme Court advocate.

NUNDY: The information that's lacking is that what does the contract really mean? What do I do if all of these promises aren't panning out the way that you promise they are?

MCCARTHY: A decision on whether to ban or to regulate surrogacy can only be taken, Nundy says, after hearing from the women whose bodies are being rented in the first place.

NUNDY: So if you've got a bunch of, you know, commercial surrogates who are saying that we need a ban, you have a ban. If you have a bunch of commercial surrogates say, no, I want to do this, but it's not fair, I need more money, then that points to a regulated industry.

MCCARTHY: Back in her room, Isha Devi says she would hope to meet the woman whose twins she is carrying. That's not likely. Doctors discourage it. It's one more uncertainty in a life bundled with them. But Isha has no doubt about one thing.

DEVI: (Speaking Hindi).

MCCARTHY: "Whatever I'm going through," she says, "nobody should go through." Julie McCarthy, NPR News, New Delhi. Transcript provided by NPR, Copyright NPR.