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Shabnam* had dreamed of owning a home for years. With few prospects for either herself or her husband, she followed the lead of many poor women in her town in western India: she signed up to carry a baby for another couple.
At the clinic of Dr Nayna Patel, perhaps India's best-known "surrogate doctor" who delivered Anand town's first surrogate baby, more women are signing up to be surrogates, with even nurses and teachers lining up, as their husbands lose their jobs.
"The women who come here usually want the money to buy a home, pay off loans, or for their children's college education," said Patel in her small clinic, the walls of which are covered with clippings and pictures of Patel with babies and parents.
Up to R70 000 compensation
A surrogate is generally paid between 250,000-400,000 and 400,000 rupees (R35 000 to R70 000), a huge sum of money in a country where many live on the equivalent of less than R18 a day.
Doctors with a Western education, top-notch facilities and lower prices have already made India an attractive destination for procedures ranging from bypass surgery to liposuction. Now lax legislation and an entrepreneurial streak in Gujarat state have helped make Anand a last stop for many childless couples at home and abroad, after its first surrogate baby five years ago.
Foreigners drawn by lower costs
In this bustling town known for India's best-known brand of butter, Patel has delivered more than 100 surrogate babies. It all began with a grandmother surrogate for a UK couple five years ago that pitched Anand and Patel into the spotlight. Following their lead, locals and foreigners began to flock to Patel's clinic, drawn by the lower costs, relaxed attitude toward surrogates and lack of legislation.
A draft bill on surrogacy is pending before parliament, but taking advantage of the state of limbo, hundreds of clinics have mushroomed across the country, with critics saying touts promoting this "reproductive tourism" care little for the health or rights of the surrogates.
Patel, who was featured on a special show on The Oprah Show two years ago, raises her voice in defence. "My argument is: the surrogate is not killing anyone, not committing an illegal or immoral act. And if a surrogate's child is able to get an education, if a family is able to buy a home, where is the harm?"
Ethical issues
Not everyone sees it that way. Patel and the couples, more than half of whom are either non-resident Indians or foreigners, have come under a barrage of criticism for "exploiting" surrogates and for glossing over the ethical debate.
Many surrogates themselves do not tell their parents or in-laws for fear of being ostracized, and several of Patel's surrogates live in an establishment called Surrogate House to ensure they have a proper diet, and are safe from drunken husbands and nosey neighbours.
Shabnam, 26, who at the time of writing was eight months pregnant with a baby she is carrying for and Indian couple resident in the US, has not told her two older daughters or her in-laws that she is a surrogate. "I don't think I can ever tell them; I don't think they'll understand," she said. She lives with a few other surrogates at the hospital with he ryoungest child, while her husband, who is unemployed since he lost his R9-a-day dishwashing job, cares for the two others at home.
Physical and emotional risk
Some experts say surrogates, who are often barely literate, do not understand all that the process entails, and are putting themselves at physical and emotional risk and foregoing their rights.
"The primary concern is the physical and mental health of the surrogate: there are several risks, including maternal mortality, associated with assisted reproductive technologies," said Preeti Nayak at Sama Resource Group for Women and Health. India's maternal mortality ratio is 301 in 100 000 births, the highest in south Asia after Bangladesh, the World Bank says.
For Chris McDaniel and his wife Shannon, who came to Anand last April from San Diego after having tried every option in the US, where hiring a surrogate can take months and cost up to $100 000 (more than R900 000), the decision to go to Patel was clear.
"It wasn't in our life plan to fly halfway around the world to a country we barely knew about to have our child," said Chris, who is writing a book on their experience.
There are few countries in which a situation like this could legally flourish. In South Africa, for instance, surrogate mothers are not allowed to profit from carrying babies for others: financial compensation is limited to loss of income and expenses.
More confident
It is hard to come by numbers of surrogates in the country, but Patel has a list of nearly 200 and is seeing more women walk in everyday because they are feeling the pinch of the slowdown.
In the absence of legislation, Patel sticks to guidelines of apex body Indian Council of Medical Research, which say a surrogate may only be implanted with the egg and sperm of the couple or anonymous donors, and that she must be below 45 years.
Patel also insists couples seeking surrogates must have a medical condition that makes child bearing impossible or risky, and will not assist gay couples and single parents.
The surrogate, who must have her husband's consent, has no rights over the baby. Nevertheless, Patel insists surrogate mothers feel empowered. "Now, they feel like they can be of some use to their family," she said.
Shabnam's ambition is far more modest. "I was very scared thinking of our situation, thinking how will we manage?" she said. "Now I feel a bit more confident. At least if we can buy a house, then things will get better." – (Rina Chandran/Reuters Health, April 2009)
*Surname withheld for reasons of privacy.
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