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Sexual and Reproductive Health Situation Report: Gestational Surrogacy in India

August 9, 2010

The Sexual and Reproductive Health and Rights (SRHR) Situation Report is a monthly column devoted to examining policy changes and issues around these critical rights around the world.

This month’s column focuses on so-called “reproductive tourism,” the growing trend of women in the U.S. finding gestational surrogates in India.  Gestational surrogacy is the practice of implanting a fertilized egg in another woman’s uterus.  Through the miracle of modern science and hassle-free air travel, western women are traveling to India, where the medical infrastructure is good and most of the doctors speak English, to find a surrogate to carry their baby.  Medical tourism has been around for a while, complete with travel agencies that set you up with the doctor and the spa/hotel where you’ll recoup after your nose job.  This new twist, however, brings up a lot of problems.

In the U.S., the surrogacy process can cost up to $100,000.  In India, it’s a steal at about $12,000.  The old familiar argument is that the women who serve as surrogates benefit from the payment they receive.  According to a Marie Claire feature story on the practice, the $5,000-$7,000 each pregnant woman is paid is equivalent to 10 years salary for rural Indians.  Women serving as surrogates quoted in the story were often using the money to improve their own children’s chances at a good life.  One woman says she now has “a chance to make good marriages for my daughters,” and another that she is working as a surrogate only to pay for the expensive medical care needed by her 8-year-old son who has a heart defect.

Human Rights Watch has a webby-nominated video on maternal death in India, and a Center for Reproductive Rights advocacy document highlights maternal mortality as a human rights and gender equity issue.  The shocking stats on maternal mortality in India, which I’ve written about before, are another powerful reminder of the context in which Indian women choose to be surrogates.  For many women without expensive medical care paid for by a rich couple, pregnancy and childbirth are a potentially life-threatening proposition.

The problem is not surrogacy itself- it’s the issue of consent and exploitation.  Poor women are being pushed by  circumstance into paid pregnancies.  In a threepart series on surrogacy for RH Reality Check, Karen Smith Rotabi writes, “poverty is coercive and the fertility choices that are made, on both sides of the global surrogacy arrangement equation, will be determined by both economic opportunity and oppression.”  The series examines the intersection between surrogacy and trafficking.

It’s difficult and ethically wooly to pay a woman to carry your child for the same reason that it is problematic to pay for organ donation; the same reason that bioethics rules limit financial compensation for people that participate in medical research.  According to the National Institutes of Health, payment could create “undue incitement” for people to participate in research that is “against their interests,” “obscure the risks,” and would preferentially attract “poorer populations.”

A number of prospective parents have expressed that it is too difficult to find a woman willing to be a surrogate in the U.S. or the U.K.  Maybe that’s because pregnancy is hard, and you’d have to be pretty poor or desperate to go through it to make a baby for someone you’ve never even met.  The Indian women profiled in every story I read on gestational surrogacy were just that– desperate to lift themselves and their families out of extreme poverty, and concerned about the future of their own children.  And many of the women who work as surrogates have to hide what they’re doing from their families or communities because it’s frowned upon and even seen as a “peculiar form of prostitution.”

This video report from Australia gives a peek into the lives of the women working as surrogates as they wait the nine months for the babies to be born.  They’re often separated from their families so that they avoid things like second-hand smoke and sex with their husbands, and many clinics house them in dormitories or hostels.

The baby business is booming.  The number of clinics in India offering surrogacy has tripled to 350 in the last five years.  The sector is predicted to generate $2.3 billion a year by 2010.  There have been a few high-profile cases of legal problems, and the Indian government is attempting to tighten the legal framework for surrogacy.  The Assisted Reproductive Technologies (Regulation) Bill is currently in draft form and would include restrictions on selling gametes, zygotes or embryos, and would explicitly lay out the “rights and duties” of surrogates and donors as well as the rights of the child.  The problem of “commodification of female reproductive organs,” as Rafia Zakaria puts it on the Ms. Blog, remains.

I’ll close with a quote from an Indian feminist sister.  Ranjana Kumari, president of a coalition of NGOs working on women’s issues, says in the Wall Street Journal, “They are using the vulnerability of the poor.  Making (a woman) a child-producing machine is not acceptable.”

Brook Elliott Buettner is a human rights policy researcher and writer.  More of her work is available at

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