Mina Chang. Originally published in Spring 2009.
As one of the world’s leading outsourcing destinations, India capitalizes on its comparative advantages to play host to a variety of foreign service sectors. But in addition to attracting commonplace jobs such as information technology (IT) services, India in recent years has seen a dramatic increase in its international surrogacy business, which serves foreign couples seeking surrogate mothers. Relative affordability combined with loose legal restrictions makes India an ideal choice for many prospective parents abroad, and the high rates of compensation for willing Indian birth mothers have created a growing pool of suppliers for the industry. Having legalized commercial surrogacy in 2002, India still grapples with a host of bioethical implications surrounding the industry. To deal with these issues, the country may need to develop a more nurturing system of legal monitoring and regulation.
The appeal of surrogacy in foreign countries like India is largely financial. While the costs of surrogacy—including medical treatment—add up to roughly US$70,000 in the United States, the same procedure costs one- seventh that price tag in India. The increasing number of Indians who speak English and the availability of advanced medical technology in India have made that nation stand out from other potential lower-cost countries.
The tempting salary has brought many willing Indian women from all regions of the country to fertility clinics in major cities. Agreeing to carry and deliver a baby may result in new houses, debt repayment, or even investments for their own children’s future. Nine months of pregnancy could produce up to US$6,000, the equivalent of 15 years’ wages for some, making surrogacy an attractive option for women from lower socio-economic levels. These demographic trends, however, have fueled concern that the new business may be just another form of class, gender, or race exploitation. Packaged as a cheap commodity, the procedure simply becomes a “womb for rent.”
As a result of similar concerns, commercial surrogacy is banned in many countries, such as the United Kingdom and Australia. For those couples unable to find altruistic surrogate mothers in these nations, Indian fertility clinics may be the answer to the problems of starting a family. But making a profit from pregnancy naturally raises ethical concerns. In India, these reproductive ethics are further complicated by questions of globalization and exploitation: is commercial surrogate motherhood oppression or opportunity? Outlawing surrogacy in 1991, France declared, “the human body is not lent out, is not rented out, and is not sold.” But in India, many take a different stance, believing that that commercial surrogacy has a positive side because it results in mutual benefits that can change lives.
While some critics’ visions of baby farms are unrealistic, the burgeoning business may foster the transition of surrogacy from an uncommon medical procedure to an option of convenience. The most significant issue, however, is that Indian law does not yet adequately address regulation of the fertility industry. Rather, it is guided only by nonbinding suggestions from a medical research council.
Thus far the self-regulation of fertility clinics has resulted in more than adequate care for surrogate mothers. But as the supply of fertility clinics increases to meet demand, the incentive to undercut competition in a developing nation may lead to unscrupulous treatment centers that would compromise the well-being of mothers. Currently, most clinics screen the profiles of prospective surrogate mothers for potential birth-related complications or mental instability. In order to lessen birth mothers’ attachment to the babies, many also stipulate using eggs from a spouse or donor to create the embryo so that the babies being carried are not biologically related to the surrogate mothers. But in addition to these requirements, counseling during and after pregnancy should be accessible for surrogate mothers due to the highly emotional aspect of pregnancy and childbirth. In a country with one of the highest maternal mortality rates in the world, the safety of the surrogate mother should also be a top priority, and she should be fully informed of the risks of the procedure.
Some of these worries may be alleviated by the likely passage of the Assisted Reproductive Technology Bill during India’s next national legislative session. The bill, which was originally tabled in 2008, is finally up for debate. It enumerates specific rights for Indian surrogate mothers, a necessary step toward regulation of what India’s Supreme Court recently termed a “vital industry.” Even with its improvements, the bill may not solve all of the ethical dilemmas attached to commercial surrogacy. The industry will undoubtedly need continued monitoring.
There are no official estimates on the number of surrogate births in India, but the Indian Council of Medical Research predicts that commercial surrogacy will grow into a nearly $US6 billion-per-year industry. But meanwhile, the lack of legal infrastructure in India’s surrogacy business is problem that needs to be addressed promptly. While helping to realize the dream of starting a family for a global clientele, India’s latest outsourced job should be monitored from the first trimesters of development to ensure the health and happiness of both its surrogate mothers and expectant couples.