Inside Story

03.01.14

The Rent-a-Womb Boom

Who really profits from India’s multimillion-dollar surrogacy industry? Adrienne Vogt explores the uncertain future of the subcontinent’s baby business.

They’ve been called “baby factories,” conjuring up images of poor, illiterate women packed into bunks and forced by their husbands to bear surrogate children for Westerners. And they make up a vital industry in India—since 2002, when surrogacy was legalized in the country, a U.N.-backed study estimates that the surrogacy business has raked in more than $400 million a year. 

More than 3,000 fertility clinics operate across India, and some can be quite flashy. Dr. Nanya Patel —who once appeared on Oprah and has been dubbed the country’s “mother of surrogacy”—says she plans to open a huge clinic that will house hundreds of Indian women, along with delivery rooms, an in-vitro fertilization department, even restaurants and a gift shop. With couples paying an average of $25,000 to $30,000 for the entire procedure, and Patel paying her surrogates around 400,000 rupees ($6,500), it’s safe to say that she’s earning a pretty penny. Since 2004, she has delivered more than 650 babies. She says she’s a feminist and her work involves “one woman helping another.”

Patel’s critics are not so sanguine when discussing the international surrogacy industry. While its promoters say it empowers women by giving them money to support their families and improve their lives—not to mention helping bring a life into another family—detractors call India’s surrogacy circuit a cruel, manipulative business that exploits powerless women in male-dominated societies.

Crystal Travis, of North Laurel, Maryland, had her three children—a five-year-old son and three-year-old twins—delivered by Patel. Since her kids were born, Travis has become deeply involved in international surrogacy and started the consulting service World of Surrogacy in 2010. She travels to India every few months to meet with doctors, and she also has around-the-clock advisers on the ground in India. She says she refuses to recommend clinics to a couple unless the doctors grant her full access to their facilities. “People don’t understand the underbelly unless you’re in the business,” she says. “You can get people who are dermatologists running an IVF clinic.”

Travis says that for many women, international surrogacy is a response to the difficulty of adopting. A product of the adoption and foster-care system herself, she notes that most people look into adoption first before turning to surrogacy, but find it uncertain and tedious. “People should have the option, if they can afford to pay for it, to have a child that’s genetically linked to them,” she says.

Prospective parents have plenty of options, all a few clicks away. A search for willing Indian surrogates on surrogacy websites yields hundreds of results. Sree, 25, from Bidhan Nagar, says, “I am housewife, want to help my husband… anything requirement i will do.” Babita, 23, from Delhi, is straightforward: “I need money. I belong to poor family.” And 23-year-old New Delhi native Bora’s answer to why she wants to be a surrogate mother? “Everything.” 

The number of children born via in-vitro fertilization is at an all-time high, according to a February 17 report. The Centers for Disease Control and Prevention estimates that 7.4 million women in the U.S. have undergone infertility treatments, likely the result of women waiting longer to have children than ever before.  

In the United States, surrogates are paid between $28,000 and $35,00, says Dr. Jeffrey Steinberg, medical director of The Fertility Institutes, a surrogacy services provider. Total surrogacy fees range from $75,000 to $120,000 , and can inch higher if complications arise.

“Surrogates [in India] are paid about one-fourth of what they would be paid here, but that’s enough to put a family of three kids through college [in India],” Steinberg says. “They see it as a real positive in Indian culture.”

Steinberg’s practice has offices in Los Angeles, New York, Guadalajara, and soon in India. He is set to open his first Mumbai center in March and has about 30 people waiting for surrogates right now. “It’s supply and demand. I’d far prefer to use American surrogates, but I just can’t get enough of them,” he says.

The screening standards for Indian surrogates are the same as for his Los Angeles practice: They have to pass medical, psychological, infectious disease, obstetrics history, and drug and alcohol tests.

Just last month, India agreed to allow frozen embryos  to be imported into the country, a decision that’s appealing to fertility doctors like Steinberg. It makes prospective parents more comfortable, because the entire medical process can be done in the U.S.; India only has to supply the surrogates, he says.

Steinberg says that he didn’t see any evidence of Indian women being exploited at clinics he’s visited. He didn’t sense any traces of stigma, either. The surrogates are able to live in apartments next to a Mumbai hospital with their families, and their children’s educational needs are taken care of, he says.

“People really have to be careful,” Travis says, “If they don’t understand the legalities of what’s going on in another country, it’s very easy to be fooled. A lot of these intended parents are willing to do almost anything to have a family.”

“As a matter of fact, I think the surrogates there may get better attention and care than the surrogates here [in the U.S.],” he says. “I was almost expecting to see them being exploited, but I just didn’t find it.”

New Delhi’s Centre for Social Research paints a less rosy picture, though. Surrogates don’t have a uniform payment structure, aren’t provided with written contracts, and some are even subject to forced impregnations and abortions without their knowledge, according to a study released last year.

So do surrogates think they are fairly treated? Most people would assume that surrogates feel a natural connection to the babies they carry for nine months. Seita Thapa, a surrogate at one New Delhi clinic, says her clinic conducted courses that “prepare us mentally for the fact it’s not our baby.” Another woman at the same clinic, Mamta Sharma, says she was able to buy a house after her surrogacy payment. “Everything has changed in my life with the money I got,” she says. Even though her extended family considers surrogacy to be shameful, Manisha Parmar became a surrogate mother at Dr. Patel’s clinic in Gujarat. She summed up the arrangement to the San Francisco Chronicle: “They need their child. I need the money.” 

If the situation sounds rather impersonal and complicated, that’s because it can be. Maulik Modi, a father to two children born via IVF, says the Indian system “is literally like a machine factory, for lack of a better word.” He says it’s nearly impossible to connect with the surrogate: “You’ve been shut out from the emotional aspect of it all. It’s probably one of my biggest regrets in life that I have my two IVF children and I never met the surrogate or the donor.”

But Modi’s story also shows how confusing international surrogacy can be. Modi, a computer programmer and self-described IVF activist, currently lives with his 4-year-old daughter in Vadodora, which is located in the country’s surrogacy hub state of Gujarat.  However, his 9-year-old son lives in Houston, Texas, with Modi’s ex-wife. Due to a myriad of immigration laws, his son and daughter are landlocked in separate countries and have never met each other. As Modi puts it, they’re “stuck in IVF purgatory.”

That’s because to bring a child into the United States, the parent must be a U.S. citizen or U.S. green-card mother. And for a child to attain U.S. citizenship, one parent must be a U.S. citizen at the time of birth and have a genetic link to the parent. Someone like Modi—who came to the U.S. from India in 1989 as an international exchange student, and received his U.S. citizenship in June 2010, a year after his daughter was born—doesn’t meet those requirements.

“Because of U.S. immigration laws, as an IVF father, I cannot bring her to the U.S. If I were a green-card mother, then I could have, but a green-card father cannot,” Modi explains. He and his then-wife had encountered five failed IVF attempts with two donors and two surrogates before conceiving their second child via IVF in January 2009. But after his wife filed for divorce that July, months before the child was born, Modi had to decide whether to stay in the U.S. where his son was living, or go to India to raise his daughter. He decided on the latter.

Both children are essentially landlocked: a court order prevents Modi from taking his son (of whom he has joint custody) outside the U.S., and the U.S. government won’t grant his daughter a passport. He’s pleaded with embassy officials, the FBI, and immigration officials for more than four years, but has been deadlocked because laws haven’t kept up with IVF technology, he says.

“My daughter has been killed. She has been made legally invisible, just like abandoned IVF children at an orphanage. They have no rights,” he says. “Why are you forcing me, as a parent, to discriminate against my own two children, who were born exactly the same way?”

As technology changes, international surrogacy laws may be forced to adapt—and there’s a faint glimmer of hope they will. Travis, the surrogacy adviser, and one of her company’s attorneys and clients met with Rep. Ted Poe, R-Texas, in early February about the need for updated laws. He seems receptive that both sides of the aisle can implement guidelines addressing IVF issues and immigration, she says.

But over in India, regulatory laws are still in flux, and they may hinder international surrogate-seekers, especially gay or lesbian couples and single parents-to-be. In July, the Indian government updated visa regulations: It now requires a special surrogate visa and a valid marriage certificate showing that parents are married for at least two years before leaving with their baby, says Steinberg, the fertility doctor. The new regulation effectively eliminated the entire ga.y community from surrogacy in India, which accounted for 60-70 percent of the total volume, Steinberg says. And officials seem steadfastly opposed to budging on the marriage certificate requirement

This year, Indian Parliament is expected to reintroduce the Assisted Reproductive Technologies Bill , or ART, which was drafted to regulate surrogacy in the country. But Travis is skeptical about the timeline — she’s heard the update may take years.

“A lot of people want [surrogacy] shut down to foreigners in general because they feel it’s too problematic,” Travis says. “They highly encourage doctors not to help singles and gays; however, many still do. If the law does get passed to shut it down for singles and gays, then that industry will cease in India.” Travis says that many are instead turning to Thailand and Nepal, but she thinks some of the surrogacy industry as a whole will move back to the United States. Every state has its own rules, but some, like New York outright ban commercialized surrogacy. Travis is currently looking into avenues that may open up affordable surrogacy in Texas or Puerto Rico.

“People really have to be careful,” Travis says, “If they don’t understand the legalities of what’s going on in another country, it’s very easy to be fooled. A lot of these intended parents are willing to do almost anything to have a family.”