Journal of Womens Health, Issues and Care ISSN: 2325-9795

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Review Article, J Womens Health Issues Care Vol: 4 Issue: 6

Surrogacy as a Growing Practice and a Controversial Reality in India: Exploring New Issues for Further Researches

Virginie Rozée Gomez1* and Sayeed Unisa2
1Institut National d’Etudes Démographiques (INED), France
2International Institute for Population Sciences (IIPS), India
Corresponding author : Virginie Rozée
Institut National d’Etudes Démographiques (INED), 133 Boulevard Davout, 75980 Paris cedex 20, France
Tel: +33 (0)6 30 72 90 65
E-mail: [email protected]
Received: December 31, 2014 Accepted: November 18, 2015 Published: November 20, 2015
Citation:Rozée V, Unisa S (2015) Surrogacy as a Growing Practice and a Controversial Reality in India: Exploring New Issues for Further Researches. J Womens Health, Issues Care 4:6. doi:10.4172/2325-9795.1000211

Abstract

Surrogacy is a burning issue in India and has often been denounced as exploitation of vulnerable women. However, it remains very poorly documented. The few existing social research studies show that India has become a top world destination for surrogacy due to strong demand, especially from foreigners, and the significant supply opportunity for poor Indian women. The issue is nevertheless a very controversial and complex one due to the specific medical, social and gender context in the subcontinent. Despite the growing media and scientific interest, and the proliferation of specialized clinics and agencies, surrogacy remains a very taboo and little known practice associated with women’s adultery. Surrogacy confronts the stigmatization of childlessness on the one hand and exposure of the reproductive female body on the other hand. Recent political change may improve surrogacy conditions and avoid possible exploitation, but at the same time it may reduce the reproductive rights opportunity for infertile people and the commercial benefit for clinics and agencies, which may not adhere to new guidelines as long as there is no law regulating surrogacy.

Keywords:

Keywords

Surrogacy; India; Gender; Infertility

Introduction

In India, surrogacy raises many questions, debates and discussions among the medical professionals, researchers and activists. Surrogacy is an old practice and it is mentioned in Bible by giving the case of Abraham and Sara. However, in modern times, discussion about surrogacy started in the late 1970s onwards. In India, surrogacy concerns very few cases: only 1% of couples consulting for Assisted Reproductive Technologies (ART) treatment [1]. But it is the most controversial infertility treatment denounced as a baby business, a capitalist market and as a patriarchal exploitation of vulnerable women, especially since India became the “world capital of commercial surrogacy” [2]. Surrogacy is then subjected to a growing interest from media, scholars and students even Non-Governmental Organisations (NGO). The controversies are intensified by the fact that in India there is no particular law of surrogacy
Surrogacy is legally considered as being part of ART treatment, which has been regulated by successive Indian Bills (Assisted Reproductive Technologies (Regulation) Bills) since 2005i. All the bill’s proposals have been developed from public debates, consultations and feedback gathered by the Indian Council of Medical Research (ICMR) which is mandated by the Indian Government. These proposals are submitted to the Government for review and modification before their final approbation as a Bill. The ART Bill 2010 was reviewed by the ICMR in 2012 but still has not been officially approved by the Government. In the meantime, in December 2012, before final approval of the draft of the last Bill, the Government of India made new proposals in a Cabinet Note. This restricted surrogacy access only to married couples and to foreigners with a medical visa (in order to avoid legal problems when foreigners wish to return to their home country with the new born). This Cabinet Note took effect in September 2013. Moreover, according to the Supreme Court Order of 2013, same-sex couples are not recognized in India. Hence, they are not eligible to have children through surrogacy. These successive changes have restricted access to surrogacy in the country.
In the subsequent guidelines, surrogacy is defined as an “arrangement” between a couple (the “intended parents”) and a woman (the “surrogate”), who agrees to receive an embryo generated from the sperm of a man who is not her husband and the oocyte from another woman, to carry a pregnancy to full term and deliver a child. The surrogacy agreement defines this arrangement between the intended parent(s), the surrogacy clinic/agency and the surrogate. This agreement must be signed with only one surrogate at a time (simultaneous contracts are no longer tolerated). The agreement provides that surrogates shall relinquish all parental rights over the child, and the birth certificate bears the name(s) of the intended parent(s). Traditional surrogacy (when the surrogate is also the oocyte donor) is no longer accepted, in order to avoid the possibility of the surrogate making a biological claim on the child after delivery [3]. Surrogates are required to fulfil a certain number of criteria: they should be between the ages of 21-35 only, be married and have their own children. Under the new guidelines, intended parents are required to be married couples with fertility problems. They are generally wealthy Indians or foreigners. They are likely to have a significant cultural, social and economic gap with surrogates, creating inequalities and possible exploitation [3,4]1.
Despite the growing interest, surrogacy in India remains a very little known and poorly documented practice. In order to better understand the practice through the discourse and experiences of the main protagonists of the surrogacy process (physicians, lawyers, associations, agencies, users), we conducted a sociological field study in Mumbai, Chennai and New Delhi between 2013 and 20142 [5]. These cities have recently become well known for the surrogacy services they offer, but this issue has not yet been thoroughly investigated. Following a literature and website search, we carried out 32 interviews with Indian and international policy makers, lawyers, medical practitioners, agencies and associations. The surrogacy clinics, agencies and law firms we contacted were later asked to help us in recruiting intended parents and surrogates. Thirty-three interviews were carried out with surrogates and eight interviews with intended parents. Interviews were in English with the professionals and intended parents and in Marathi, Hindi or Tamil with the surrogates with the help of an independent translator appointed by the researcher, or, in few cases, of a person from the clinic staff3.
In order to provide a comprehensive overview of surrogacy in India, in addition to our own study (Rozée 2015), other relevant field studies conducted in India since 2006 are included. The Table 1 below gives the details of studies reviewed in this paper, with the number of interviews conducted with the various persons involved in the process of surrogacy.
Table 1: Details of studies used in this paper with the number of interviews conducted with different stock holders of surrogacy.
Drawing on these sociological and anthropological studies and documentaries, this paper aims to understand why the growing practice of surrogacy in India is becoming a very controversial reality. The economic, cultural and social context in India may explain the expansion of surrogacy, in particular through the specific characteristics of supply and demand. Gender relationships and constructions may also help to understand the controversies surrounding surrogacy in the country. Analysis of these findings leads to new questions and issues to be investigated in the future.

India as the World Capital of Surrogacy: Demand and Supply

In the last decade, India became, after the United States, a major destination for surrogacy. According to the Global Surrogate Mothers Advancing Rights (G-Smart) it may be used by 50,000 couples per year (there are as yet no official data on surrogacy in India). Both demand and supply are high in India, due to the economic and political background of the intended parents (who come from developed countries where surrogacy may be banned), the numerous facilities offered by the medical community and the low socio-economic background of Indian women, a plentiful source of “reproductive labor”.
A great demand opportunity: Economical facilities in an “uncontrolled” environment
All the above-mentioned studies indicate that the majority of intended parents come from abroad, mainly from the United States, Australia, and the United Kingdom, while a few originate from Sweden, Norway, Spain, Israel, Japan and Middle Eastern countries. In our sample, intended parents were Australian (n=4), Indian (n=3) and French (n=1). They were of middle to high social class in their country of origin (considering occupation level only). As in other studies, the intended parents in our sample were childless heterosexual couples or same-sex couples. It should be noted that all the field studies that are used in this paper were carried out before the Supreme Court judgment in 2013 regarding the unacceptability of same-sex couples.
Our interviews with professionals revealed that intended parents opt for surrogacy as a last resort and a last chance to have a baby. They seek surrogacy services for six main reasons. Firstly, the couples had experienced several failures of infertility treatments and/or repetitive miscarriages. Secondly, they have an irreversible disease that does not allow the woman to become pregnant. Thirdly, they are gay couples or single men and surrogacy is the only medical way for them to have a baby. Fourthly, it is also a way to have a baby who is genetically linked to one or both parents, and in most countries this may be a crucial factor for them and for their family. In most countries in the world, parenthood is socially valued when it remains based on blood and genetic ties [6]. Beyond the real desire to conceive and have a child, another reason may be the stigmatization of childlessness and infertility in India [7], as in other northern and southern countries. Parenthood, and particularly motherhood, makes it possible to acquire a better status in society [8]. The sixth reason is that surrogacy is a better option than adoption, which is considered to be longer, more restrictive, complicated and expensive than (transnational) surrogacy [9], and is even sometimes prohibited, as in the case of irreversible illness or for same-sex couples.
Intended parents from other countries decide to use surrogacy in India because in their home country the practice is prohibited or unavailable. In our sample, Australian intended parents could have engaged in the surrogacy process in their country: surrogacy is allowed in some Australian states, but on an exclusively altruistic basis (i.e. without any financial agreement). Australian intended parents declared that it was quite impossible to find voluntary surrogates and they did not want to ask friends or family members to bear a child for them. Intended parents, therefore, go abroad for surrogacy to escape legal restrictions and they choose India for both political and economic reasons. Surrogacy in India takes place in an uncontrolled environment. This may be seen as a barrier (no legal guarantee that the intended parents will be able to have or to keep the child) but it may be interpreted as an opportunity for flexibility and autonomy with regard to the modalities of surrogacy. It has also led to the proliferation of surrogacy clinics and agencies, offering a considerable range of choices and possibilities. Moreover, in the case of surrogacy in India, the birth certificate directly mentions the name of the intended mother as the mother of the child. In other countries such as the United States or Thailand, the name of the surrogate is mentioned on the birth certificate and further legal procedures are required to officially become the parents of the child. Agencies explain that this is a decisive factor encouraging foreigners to use surrogacy in India rather than elsewhere.
The main reason why foreigners choose India for surrogacy is nevertheless the low cost. While surrogacy costs around $70,000- 100,000 in the United States, it costs around $35,000-40,000 in India, depending on the locality and the clinic. For the same financial cost as a single surrogacy cycle in the United States for instance, intended parents can make several attempts in India and so increase their chances of having a baby [10]. Indian physicians are well qualified and provide advanced treatment technologies. Better quality at lower cost motivates couples to visit India for surrogacy. Another important reason, apart from legal and economic factors, is the use of the English language in clinics: it is much easier to undergo care and to complete all administrative and legal documents in English. In the study conducted by Pande, some of the intended parents also declared that they choose India for surrogacy in order to help a woman and a family in financial need. This author cites similar reasons quoted in other research on the adoption of children from developing countries [11].
Availability of surrogates: Plentiful supply due to poor economic conditions
India has also become one of the top destinations for surrogacy because of its population context. As Rudrappa states, India has a significant reserve of reproductive workers: “the easy availability of working-class Indian women who form a compliant labour market in surrogate mothers has made India the “mother destination”” (2012: 77).
Studies have shown that nearly all surrogates met the main criteria set out in the Assisted Reproductive Technologies (Regulation) Bill 20104 in terms of age and family situation [15]. They are mainly married, but sometimes divorced or no longer living with their husband, and they all have at least one child. They are mainly Hindu, but some women are Muslims or Christians. Their education level differs depending on the study: mainly primary level [16], from illiterate to secondary [11], or from illiterate to (secondary) high school level [13,14], as we also observed [15]. While some women were housewives before the surrogacy agreement, the majority were employed as housemaids, garment workers, or worked in private services. Depending on the study, before the surrogacy agreement the family income was between $15 and $200 per month. The mean family income in India is around $66 per month (Indian Human Development Survey 2004-2005). Contrary to “predictions”, the surrogates investigated are neither among the least literate nor the poorest women and families of India [15,17].
Nevertheless, money is the main motivation for women to become surrogates in India, as the amount involved is significant. The women earn from $2,300 to $9,800 depending on the study, with additional payments in the event of multiple pregnancies and/or a cesarean delivery. Some further reasons emerged in our study, as in other research: surrogacy was a better and easier option than their previous job [15,18], satisfaction in helping people and bringing them happiness [3], and doing something good and rewarding in their life. The decision to become a surrogate is never described by the women as being made under force, threats or coercion (although this observation needs to be further explored). However, this “free” choice hides socioeconomic and gender constraints [19]. Sometimes women engage in surrogacy to pay bills, rent or debts, to buy their own apartment or room, to buy an auto rickshaw for their husband, to support their family and parents-in-law, or to improve their standard of living. They also do so to provide a better life for their children. Some surrogates we met, like the woman interviewed in Made in India [10], stated for instance that the money was intended for a dowry to enable their daughter to make what they call a “good” marriage. Surrogacy as a “survival strategy” [20] then appears as an insufficient reason in itself. The main motivation to become surrogates is indeed directly economic but it is also indirectly sociological: to fulfil their role of mother and wife in the family [5].
Migration may be also a key factor explaining the availability of Indian women for surrogacy. As we already mentioned, the practice of surrogacy occurs exclusively in Indian cities, even very large cities, which attract many migrant workers from villages or from rural areas. Like women engaging in other controversial female activities such as prostitution or domestic work [21,22], some surrogates were also reported as being migrants, coming from another Indian state or from a rural area. Economic and labor instability and insecurity related to migration, as well as their vulnerability as migrants, may push women and couples to commit to the surrogacy process in order to improve their living conditions; living far from the family may also help to take the decision to become surrogates without family pressure or stigmatization related to the practice. Data are lacking to evaluate the migration factor in surrogacy and this needs to be explored in the future.
Three “Ideal-Types” of Indian surrogate seem to have emerged so far. Some women became surrogates because this was a personal decision (they are single mothers, divorced, widows, or separated with children) and want to improve the living conditions of their household. They aspire to a better life for themselves and for their children; surrogacy appears as a means to empowerment and independence (the money will for instance be used to buy their own apartment that will allow them to leave their husband or family-inlaw). Other surrogates correspond to the ideal of the devoted Indian wife and mother: they became surrogates because they need to support their husband and parents-in-law. Here, there is the idea of a personal sacrifice for collective well-being. Finally, some surrogates have the same profiles and motivations as the previous ones but the “sacrifice” is also connected with a God-given opportunity to do an “act of grace” (giving a child to a childless couple). Surrogacy is considered here as a chance given by God to improve family conditions and to bring happiness [5].
India’s position as a capital of surrogacy is explained by both specific demand and supply in a favorable economic and political context. The Indian medical practitioners and lawyers we met described surrogacy in India as a “win-win situation”: surrogates earn a large amount of money that they could not have expected from another activity, and intended parents finally have a baby. These opportunities, which are nevertheless progressively being reduced through political changes, occur in a complex social environment, where surrogacy is at the same time expanding and taboo, and is simultaneously associated with Indian women’s salvation and empowerment and with an offense against morality.

Social Cultural Context of Surrogacy in India

Surrogacy arouses huge curiosity because of its growth and because of several scandals reported by the press, such as the famous case of Baby Manji in 2009 [23], the death of an egg donor in Mumbai in 2010 [24] and the death of a surrogate in Anand in 2012 [25]. It then became a public issue, particularly through the increasingly numerous articles in the Indian and international press over the last decade (Wall Street Journal, New York Times, London Evening Standard, Spiegel Online, The Times of India, Mumbai Mirror, The Telegraph, etc.). The issue of surrogacy is also analyzed, highlighted and disseminated by NGO reports and by the increasing number of academic theses, generating the reinforcement of feminist discussions and the development of “cultural products” [26]. This issue is covered by documentaries, Indian movies including a Marathi movie [27], and novels such as Origins of Love by the famous writer Kishwar Desai [28]. The reality and social complexity of surrogacy appear to be linked to the complexity and culture of Indian society itself. Religion is one example and the Bollywood system is another.
Hinduism as an impeller and inhibitor element and Bollywood as a dissemination catalyst
Hinduism, which is the main religion in the country and which permeates the social norms of Indian society, appears as a key element when analyzing surrogacy issues. Buddhism allows surrogacy whereas Catholicism and Islam condemn it. However, Hinduism appears simultaneously as both compatible and incompatible with surrogacy practice [29].
Intended parents and society in general have to deal with two antagonistic religious constructions. On one hand, it is important for Indians (especially Indian women) to ensure that the family has blood descendants – to have a child genetically linked with the parents or family (this may go against surrogacy because intended parents generally use egg donors). On the other hand, in Hindu mythology, many children were conceived outside the mother’s body and sometimes with the sperm of a person other than the father (this is in line with surrogacy).
In the same way, surrogates have to deal with antagonistic religious beliefs and practices. According to Hinduism, it is important to perform good actions in the current life in order to be rewarded in the next life [30]. This may be a motivation for surrogates, as we observed in Mumbai. On the contrary, scientific studies on motherhood in India show that pregnancy and delivery are culturally considered as impure elements and pregnancy has to be accompanied by a number of rituals, mainly in rural areas [31].
Another important cultural factor to consider in India and especially in Mumbai is Bollywood, which encourages the “dissemination” of surrogacy. All residents in Mumbai are aware of and very attached to Bollywood films and protagonists. Bollywood is a key player in the evolution of society. Very famous actors such as Shah Rukh Khan, Aamir Khan and Salman Khan’s brother (Sohail Khan) have used surrogacy to have a child5, allowing the practice to become less taboo (at least in some social classes). Unlike the press releases and the debates on surrogacy, none of these famous cases have led to scandals. The only controversy concerned the last baby of Shah Rukh Khan and the fact that “sex selection” may have been used in order to have a baby boy (a practice prohibited in India), but never the fact that he used surrogacy [32].
Despite the increasing number of clinics and agencies in India, despite the use of surrogacy by these very famous Bollywood actors, despite the proliferation of press articles on this topic, surrogacy is still a hidden and taboo practice for the majority of society. All medical professionals we met argued that surrogacy is accepted in society (which was however not the case 5 years ago) in particular thanks to Bollywood stars. Nevertheless, intended parents and surrogates rarely share this experience with their family and neighbourhood.
A hidden and taboo practice
Existing field studies report only a few interviews with intended parents (fewer than surrogate interviews), including in very wellknown surrogacy clinics receiving many infertile couples. Medical practitioners and lawyers explained that intended parents were not willing to talk about their experience. In India as elsewhere, infertility and surrogacy as a last resort to have a baby are always described as a morally and socially painful experience, with major social consequences for the couple and for the woman [33,34]. Among the few intended parents interviewed in studies, some (mostly foreigners and gay couples) are willing to disclose the use of surrogacy. But most Indian couples will not disclose it because they declare it is a personal issue or “because of society”. In the same way, most of them have not shared and will not share their surrogacy experience with anyone. This feeds the taboo of surrogacy in India, essentially due to the stigmatization of infertility in the country.
On the surrogate’s side, some medical practitioners explained that surrogates did not want to be interviewed, or that their family did not allow them to do so. Only a very few of the surrogates who participated in the studies stated that they hadn’t told their family (except the immediate family) or their friends or neighbours that they were surrogates. If people ask them about the pregnancy when it becomes apparent, the majority intend to answer that they are expecting their own child. Surrogacy is hidden because of the negative and stigmatizing opinion in which it is held and by the fear of being mocked or rejected. Medical professionals encourage this secrecy: some of them advise surrogates not to spend too much money at any one time in order to avoid questions. Surrogates are sometimes kept in a particular place, in a “surrogacy house” or “hostel” [35], to facilitate medical surveillance but also, according to medical practitioners we met, to protect surrogates from the regard of others, as also observed by Vora [13]. Some surrogates declared that they preferred staying away from the family and neighbourhood during the pregnancy.
Surrogates, including those interviewed for our study, claimed that they are doing nothing wrong and they resist stigmatization [5,36]. They nevertheless declared that other people think differently. Surrogacy is commonly associated with the baby trade but also with immorality. The method of becoming pregnant, through in vitro fertilization which does not involve sexual intercourse, is an unknown and unthinkable medical practice. People would therefore believe that the surrogate had sexual intercourse with a man other than her husband. Researchers often compared surrogacy to prostitution: making female bodies available to other people in order to make money. But according to Indian surrogates themselves, surrogacy is generally socially considered as adultery, which is particularly condemned in Indian society, especially when it is committed by a woman. In general, female sexuality and body exposure is taboo in India, and the monetary use of the female body leads systematically to controversies in the country: socially it is considered as immoral and scientifically it is interpreted as violating the traditional patriarchal system. A salient example of this is all the controversies on sex workers, and in Mumbai on bar dancers, who have been prohibited in the city since 2005 [37], and more recently the discussions on lingerie-clad mannequins [38].
According to Tabet [39], reproduction is a job, and even a job in which women are exploited. Following field studies in India, surrogacy is also considered by some scholars and some surrogacy protagonists themselves as labor (even as “dirty” labor, according to Pande 2010 [36]. It is an interesting approach to develop, comparing surrogacy with other jobs involving the body. It would be an opportunity to deepen the usual parallelism with prostitution; to compare surrogacy to the very controversial work of bar dancers and to other hard work (for both males and females) involving the body that is less subject to debate.
A Difficult issue to investigate
Although surrogacy is a growing practice that is subject to increasing public debate and academic interest, it remains very difficult in India to collect and produce empirical data on the subject because of its taboo nature and the controversies surrounding it. As evidence, there are only a few Indian and international field studies on this topic, with limited samples. The works referred to here concerned only seven cities and six states, and they report cases of between 12 and 100 surrogates, and of 1 and 50 intended parents.
One of the foremost difficulties in the study of surrogacy is the identification of clinics and recruitment agencies. In Mumbai for instance, surrogacy clinics, agencies and law firms seem to be well established but are not publicly visible: their offices and consulting rooms are in buildings or shopping malls and may therefore be invisible from outside. Surrogacy is not always mentioned among the areas of medical care proposed by clinics. Then, because of the proliferation of surrogacy institutions in Mumbai as in other large Indian cities, it is difficult to select the “best” clinic, agency or law firm in order to perform a relevant study. Moreover, if only a few clinics or law firms are selected for interviews with professionals, intended parents and surrogates, this limits sample representativeness.
It is also difficult to meet medical practitioners and lawyers and to obtain their cooperation [5,18]. Many medical practitioners did not answer our e-mails. Among those we met and interviewed, some refused to put us in touch with their patients. According to some e-mail feedback we received, full collaboration is difficult to obtain for three main reasons: the recent growing interest and controversies reported in the media that may suppose possible judgement and criticism, especially from a European and French person; confidentiality and anonymity that may be threatened by the presence of the researcher; and the recent political changes (from September 2013) that limit the use of surrogacy for foreigners to those with a medical visa and prohibit it for gay couples. Clinics have to reorganize themselves, to deal with ex-intended parents who no longer fulfil the new criteria fixed by the Government and who always have some frozen embryos [40,41]. It is not mandatory to comply with the Guidelines and Cabinet Note. But clinics are nevertheless compelled to adhere as far as possible to the new conditions regarding intended parents, because, since September 2013, the Foreigner Regional Registration Offices (FRRO) are not supposed to deliver exit visas for surrogate children if the parents do not meet the required criteria. The last feedback we received from one recruited clinic confirmed the impact of these political changes: “The hurdle that we are facing now is the changes in the surrogacy laws that have made things so much more complicated and hence, we would like to put the SM [Surrogate Mothers] interview on hold for a while. We hope you understand” (clinic selected for the study, excerpt from an e-mail dated January 2014).
Surrogacy in India appears to be dominated by biomedical power. It is totally controlled and managed by clinics and agencies in order to satisfy the demand (intended parents) and to optimize the success rate (to obtain a healthy baby). Research on surrogacy by social scientists could interfere with the routine process of satisfying the demand for a healthy child by intended parents. In the documentary by Sharma [42] for instance, even outside the clinics, surrogates and agents had to ask the clinic’s authorization to be interviewed. During our research, the intended parents and in particular the surrogates we met were nearly always previously selected by clinics and agencies. In some clinics and agencies, interviews with surrogates were attended by a doctor or another professional. This obviously leads to bias with regard to the interview content and the surrogate’s discourse. We also had to sign documents pledging ourselves, among other conditions, not to contact surrogates without the clinic’s authorization or outside the clinic (without a clinic representative).
All these conditions and precautions imposed by surrogacy professionals in order to preserve users’ secrecy and confidentiality and their own control over the process interfere in the quantity and quality of the data collected. Nevertheless, more insightful studies are required to explain and understand the practice of surrogacy in India. Detailed studies will be needed to provide an answer to the numerous debates on the logic and growth of surrogacy, its expansion and the reasons behind surrogacy for intended parents and Indian women. The findings of such studies will help to avoid the possibility of exploitation and perverse effects.

Conclusion: Impacts of Surrogacy

Surrogacy in India is analyzed in this paper from different perspectives covering a large geographical area. National and international gender and feminist activists, like international public opinion, mainly consider surrogacy as exploitation. Moreover, we need to understand the exact meaning of this term, i.e. exploitation of the female body? of disadvantaged social classes? of labor workers? Some feminists and researchers have also interpreted surrogacy as a reproductive right. But reproductive rights for whom? intended parents? surrogates? For intended parents, the opportunity to conceive and to have a child in spite of life choices or life conditions (same-sex couples, older women) or physical incapacity (heterosexual couples with diagnosed infertility). For surrogates, de facto, they appear to have decided to make their body available for someone else without coercion and violence, but they are indirectly forced to do so because of economic and gender constraints. How far can this be considered as a reproductive right?
We can see today two paradoxical main currents of thought. On the one hand, surrogacy, as a globalized practice, is becoming increasingly visible and arouses growing interest from every part of society. On the other hand, since India opened up to globalization in the 1990s, we see a strengthening of traditional patterns, also in relation to women and the family, which stigmatizes women’s sexuality (surrogacy being interpreted as extra-marital intercourse) and overvalues family and motherhood. Indian women have to deal with this paradoxical context. This all takes place against a background of inequalities: surrogacy demands come from affluent people and surrogacy offers from more economically vulnerable women. Surrogacy seems to act as a magnifying glass of Indian gender relationships and socio-economic and medical environments.
Discussions about the morality of surrogacy today serve no purpose according to researchers working on this issue in India, as it has become a reality and even for some, a job. However, one important point needs to be apprehended and further investigated. A few of the surrogates we met decided to repeat the experience, to bear another baby for another couple, mainly for the financial reason that all the money earned with the first surrogacy was already spent. To our question “Would you allow your daughter to become a surrogate?”, some surrogates declared that they were doing so precisely to avoid their daughter having to do so in the future. That questions the real impact of the practice for surrogates themselves, their family and their children. Does it really lead to improved economic and gender conditions? With surrogacy, women earn (more) money for the family and household. Does this lead to a gain of decision-making power within the family and the marital relationship? An economic analysis of bargaining power showed that “the greater a person’s ability to physically survive outside the family, the greater would be her/his bargaining power over subsistence within the family” [43]. Are the relationships with the parents-in-law, with the husband becoming more equal after surrogacy? On the other hand, are living conditions economically and socially better for the family and the children? Do children for instance improve their educational level and their standards of living afterward?
Some professionals are showing interest in improving the condition of surrogates and surrogacy in India. For instance, Dr. Patel who runs a clinic in Anand has created a Surrogate Trust [35] and a Gramin Bank to help surrogates to save money and to pay their children’s school fees. All researchers and people we met including physicians and lawyers agree that a law is needed to prevent unethical practices and possible exploitation. However, discussion on such a law has been pending for several years, as it is not a priority of the Government which faces poverty and political instability in some regions.
The political changes aim to better regulate the practice and may reduce exploitation and misdemeanours. But they may also impair economic opportunities for women and possible reproductive rights, and at a macroeconomic level, reduce the business of surrogacy6. Even the impact of guidelines or future law may be controversial. In the meantime, India appears to be losing its place as a capital, dethroned by Thailand (no law, same medical quality and facilities as India, and more “gay friendly”), before however the last mediatized scandals [44] and the definitive ban on surrogacy for foreigners in 2014. Some other countries, like some Latin American countries (for instance Mexico) where there is also no legislation, seem recently to be emerging as new international destinations for surrogacy.
1National Guidelines for Accreditation, Supervision and Regulation of ART Clinics in India, 2005; Assisted Reproductive Technology (Regulation) Bill, 2008; Assisted Reproductive Technologies (Regulation) Bill 2010.
2Research project funded by the European Research Agency, Marie Curie Programme (7th PC / 2007-2013).
3This research obtained the approval of IIPS Ethical Review Committee (May 21, 2013).
4http://icmr.nic.in/guide/ART%20REGULATION%20Draft%20Bill1.pdf
5http://archives.deccanchronicle.com/130629/entertainment-bollywood/article/shah-rukhs-surrogate-baby-boy
6Studies generally used the same reference to show the profits for the country related to surrogacy: according to the Economic Times in 25 August 2008, Surrogacy in India is estimated to be a $ 445 million business.

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