Monday, 16 November 2015

Wombs for cash: Surrogate mother ‘renting’ womb for £8,500 implanted with embryo created from an HIV+ father

A Mexican woman who agreed to be a surrogate mother and ‘rent’ her womb for £8,500 was implanted with an embryo created from an HIV+ father without her consent.
Alejandra Mendiola, a 36-year-old single mother of four, agreed to carry a baby made from donated sperm and eggs for an American client because she desperately needs the money.
‘I am six months pregnant and I only found out a few weeks ago that the man who is paying me to carry his child is HIV+,’ she told Channel 4’s Unreported World.
‘I am scared and unsure what is going to happen to me and my children.
‘I only did this because I wanted to secure their future – now I’m frightened for my future, and my children’s.’
Global commercial surrogacy, where a woman is paid to carry an embryo with which she shares no genetic link, is an exploding industry estimated to be worth up to £1.3 billion.
In Britain, paying for surrogacy is illegal and contracts between parents and a surrogate mother are not legally enforceable. Women who carry babies for other people can only do so altruistically, receiving only very basic expenses.
This means many British people desperate to have a family look abroad.
Until recently, Thailand and India were the top destinations for international surrogacy.

But earlier this year, the Thai government banned non-Thai and gay couples from accessing surrogacy services after an Australian couple allegedly abandoned a baby with Down’s syndrome while taking home his healthy twin sister.

'Ban on surrogacy will lead to exploitation'

BENGALURU: The Centre's move to ban commercial surrogacy and encourage only for altruistic purposes is ridiculous, says Sharmila Rudrappa, professor of sociology and Asian American Studies at the University of Texas. Sharmila, who has researched surrogacy in Benglauru extensively, told TOI that the move will only exacerbate the situation for surrogate mothers. Her book, Discounted Life: The Price of Global Surrogacy in India, will be published in December. Excerpts:

India has proposed to ban its women from being surrogates for NRI, PIO and foreign couples

This ban is certainly going to dent the earnings of surrogate mothers, but it's not going to be that large. But what's worse is the Centre is looking to ban commercial surrogacy altogether. It wants to institute only altruistic surrogacy , where no money will be exchanged. Look, the cat is out of the bag -the businesses are set, doctors have invested in equipment, networks are established. To think that you can turn the clock back and go back to altruistic surrogacy is downright ridiculous. The Centre has no interest in regulating surrogacy, and helping surrogate mothers achieve a life of dignity. Now, they are expected to gift their labour and hardship. There may be no contracts. Rich families can coerce or compel their poorer relatives, or maids to engage in "altruistic" surrogacy for them. Under these conditions, exploitation of surrogate mothers will deepen.

What led you to conduct research on surrogate mothers in India, Bengaluru specifically?

I still have a family in Bengaluru and during my visits, I was struck by the growing presence of fertility clinics all over the city. Why were there so many fertility clinics? It was right around then, in October 2007, that Oprah Winfrey had a show on surrogacy in Anand. I slowly realized that perhaps infertility and surrogacy were fascinating topics, especially given the amount of time, money and effort various governments in India had put in to control women's fertility .

Women in some rural pockets near Bengaluru are pushed into renting their wombs to earn money.

Please don't refer to surrogacy as a rental relationship. Such a perspective, i.e., that women "rent their wombs", discredits their efforts and sacrific es. Their bodies are pumped with synthetic hormones, they undergo invasive ultrasounds, they are separated from their families for months and stay in surrogacy dormitories, and finally, they are almost always cut open. The industry has a very high incidence of caesarian surgeries.

Given that these surrogate mothers have very poor postnatal care, the risks they put their bodies through are cause for worry . The women I met know that surrogacy is risky but still pursue surrogacy because life has become expensive in Bengaluru. None of the women I met was from rural areas. They were all Bengaluru residents, or came from the outskirts. And none of them was desperately poor; they came from multi-income families. They believed that the wages from surrogacy could pull them out of economic uncertainty .

Where exactly does a woman from Karnataka stand in the global reproductive labour market?

When I conducted fieldwork in Bengaluru in 2011, they received $4,000 for each pregnancy. By 2012-13, they were receiving $5,000. People might think this is very good money , but the city is expensive and it disappears very quickly.

Clarity sought on Centre’s ban on surrogacy for foreigners New directive of ICMR leaves Indians married to outsiders and NRIs in a fix

A recent notice (dated October 10) from the Indian Council of Medical Research (ICMR) to leading In Vitro Fertilisation (IVF) clinics in Hyderabad has become a source of anguish for the Chowdhary couple. The cause for worry is the ICMR directive to clinics that said ‘surrogacy will be limited to Indian married couples only and not to foreigners’.

“I am a person of Indian origin and my parents are from Hyderabad. I am settled in New Zealand but my father, mother and other relatives live here. What should I do now? Will the Indian government consider me a foreigner?” asks an upset Ramesh Chowdhary (first name changed on request).

The couple from New Zealand had come to Hyderabad and underwent IVF treatment in the hope of having a child. And when IVF failed, surrogacy was the only option left. The recent decision of the Union government to ban surrogacy for foreigners has put the couple and the IVF clinic in a fix, prompting the clinic management to write a letter to the ICMR seeking clarification on the classification of foreigners.

The decision to ban surrogacy among foreigners has raised some prickly questions among IVF clinics in Telangana because there is no clarity whether surrogacy facilities can be extended to Indians married to foreigners, NRIs and persons of Indian origin.

Then, there are also the questions of commercialisation, involvement of third party (known as agents) and exploitation of the gullible people that have been largely left unanswered.

“I am not sure how this decision to ban surrogacy for foreigners will help. However, there is a definite need to strengthen regulatory aspects of commercialisation, involvement of agents and the threat of exploitation of families. There is also a lot of clarity needed on issuing of visas for the baby born out of surrogacy for a foreign couple,” says Dr. K. Anuradha of the Anu Test Tube Baby Centre.

Many also cite the lack of clarity on legal issues pertaining to surrogacy.

“There is no clarity of rules on surrogacy. Moreover, there is a thin line that divides altruistic and commercial surrogacy. Many couples prefer to bring their close relatives as surrogates who can bear children for them. However, not all are lucky. Such persons do try to opt the commercial way of surrogacy,” says Dr. P Praveena, Baby’s Life Hospital, Hanamkonda, Warangal.

Specialists in the sector agree to the fact that in developed countries, IVF and surrogacy are prohibitively expensive, which drives foreigners to destinations like India and Thailand.

Deep-rooted issues

However, they point out that banning surrogacy to foreigners does not necessarily address the deep-rooted issues like the health of a surrogate mother, who will take responsibility of the surrogate infant in case they have a congenital condition or an abnormality.

IVF specialists also draw attention towards family disputes related to property etc. “There is definitely two sides to the story. What if the surrogate mother after few years decides to claim the surrogate child? However, for women from poor families, it could be a good option,” says Dr. E. Kavitha Reddy, senior Gynaecologist and IMA secretary from Nizamabad.

“What is the need of the hour is to regulate third party reproduction protecting all stakeholders, not ban a technology which can help infertile couple,” said co-chairman, Nova IVI Fertility Centre, India, Dr. Manish Banker.

(With inputs from Gollapudi Srinivas Rao in Warangal and P. Ram Mohan in Nizamabad)

Saturday, 14 November 2015

Banning Surrogacy in India Will Drive It Underground

The Indian government is set to ban surrogacy for foreign couples much to the chagrin of these parenthood hopefuls, surrogate mothers and the doctors involved in the surrogacy process. The issue of surrogacy, particularly that of commercial nature, is a polarising issue across the world.
Even the developed countries stand divided on it. While many states in the US allow commercial surrogacy, France, Germany, Spain and Italy have banned all kinds of surrogacy. Some countries like the UK, Denmark and Belgium allow only altruistic surrogacy.
In the aftermath of the Indian Council of Medical Research’s recent letter to infertility specialists directing them against entertaining foreigners for surrogacy services, a strong demand for better regulations instead of a blanket ban has emerged.

While one may choose to ignore the moral strings attached to surrogacy, it is impossible to ignore the ethical issue of using the bodies of women from economically weak sections of society. It is na├»ve to assume that all surrogate mothers have a choice in the matter. As in sex work, women’s bodies are at the disposal of those who can afford to use them. Even if the complex issue of choice and agency could be resolved, women’s health opens a Pandora’s Box of contradictions.

Can We Turn Stem Cells Into Eggs?

Northwestern University biologist Jonathan Tilly is certain he’s found egg-making stem cells in adult mice. If he’s right, it would refute decades-old work that showed female mammals finish making all their eggs before or shortly after birth. This might make it possible to grow new eggs inside the ovaries of older women.

In a feature for Science last week, Jennifer Couzin-Frankel wrote about the ongoing scepticism many reproductive biologists have towards both Tilly’s work and OvaScience, the fertility-treatment company he helped found.

Tilly says he’s proven the existence of these stem cells by every method imaginable. But sceptics, and there are many, argue that he has relied chiefly on appearance and genetic markers to identify them. Most reproductive biologists insist that the cells be caught in the act of undergoing meiosis, the cell division unique to sperm and eggs in which bits of DNA are swapped between chromosomes. They also want to see that the resulting eggs can be fertilised and create offspring.
In short, before reproductive biologists are willing to agree that Tilly has found precursors of eggs, they want to see evidence that these cells actually turn into eggs.

Nevertheless, OvaScience has pressed on: it now offers their first modification of standard IVF based on the disputed research in Canada, Panama, Spain, Turkey, and Dubai. In the AUGMENT treatment, mitochondria are isolated from the putative immature egg cells and injected into a patient’s egg along with a sperm cell.

AUGMENT costs $US25,000 on top of the astronomical costs of a ‘normal’ round of IVF, and although the company claims the technique can give older eggs additional energy for early development, so far all of its successes have been in younger women. Some critics say AUGMENT’s chances of success are no different than normal IVF: if true, women using it could be doubling the price of their treatment for no good reason.

Legal experts seek new surrogacy law

Eminent legal experts and jurists have called upon Parliament to enact a new law to deal with issues concerning surrogacy and inter-country adoption.
Referring to the government’s move to bring a law on surrogacy to prohibit commercial surrogacy, the speakers said the need of the hour was to enact a comprehensive law which will also deal with problems of inter-country adoption.
The Assisted Reproductive Technology (Regulation) Bill, 2014 proposes to regulate and supervise surrogacy clinics, prevent misuse of ART technology, besides advocating safe and ethical practices of ART services.
The seminar was held in the capital last Friday to coincide with the release of a book, Surrogacy in India: A Law in the making — Revisited, authored by advcoates Anil and Ranjit Malhotra by Justice A.K. Sikri of the Supreme Court. The book examines this journey of surrogacy in India from 2005 to 2015. Former Attorney General Soli Sorabjee, Lord Diljit Rana, British Member of Parliament and Dr. Kavita A. Sharma, President, South Asian University, were the special invitees.
Speakers said the Bill contemplates that surrogacy shall be available to married Indian infertile couples only. It is proposed that foreigners, whether single or couples, with the exception of OCIs, NRIs, PIOs and foreigners married to Indian citizens, will be disallowed surrogacy in India. They said in reality, commercial surrogacy is in existence for the past over ten years and has become an unregulated medical tourism industry.
The speakers said inter-parental child removal from one country to another is not defined in any Indian legislation and is not specified as an offence under any statutory law.
The problem is compounded by the fact that India is not a signatory to the Hague Convention on Civil Aspects of International Child Abduction, 1980, which is acceded to by 93 countries worldwide. Hence, inter-parental child custody conflicts are invariably decided by Indian Courts on the principle of the welfare of the child as a paramount consideration in the best interest of the child.

A fugitive non-resident Indian parent declared a proclaimed offender in matrimonial proceedings may not even be able to see or talk to his children removed to India. An anguished parent armed with a foreign Court order and unsuccessful in its enforcement in India, attempts to abduct his own child in an attempt to repeat what the other parent did. They wanted a uniform line of thinking to give consistency in dispensation of justice till a legislative solution emerges.

Tuesday, 10 November 2015

Commercial surrogacy risks exploitation of women

The Ministry of Health and Family Welfare has called for comments on the proposed Assisted Reproductive Technology (ART) Bill 2015 soon to be tabled in Parliament. This Bill attempts to institute governing structures for and supervision of infertility clinics. By far, the most controversial issue is this area is commercial surrogacy arrangement. In 2005, the ICMR National Guidelines for Accreditation, Supervision and Regulations of ART Clinics allowed commercial surrogacy in India. 

This inexplicable and unjustifiable decision shocked civil society and the medical fraternity, as commercial surrogacy is strictly banned in almost all countries of the world. Since then, with every scandal or tragedy involving exploitation of surrogates or abandonment of children, the image of India has been tarnished and tagged with derogatory terms like ‘rent-a-womb’ and ‘outsourcing babies’.

The main beneficiaries of these arrangements would be the clinics offering these services to well-heeled affluent clients from abroad, who are delighted with this form of medical tourism that allows surrogacy arrangements for a fraction of the cost abroad. Vocal protests by women’s groups, human rights groups and other professionals against this blatant exploitation of poor and vulnerable Indian women have been ineffective. The government has remained silent and continued to allow vested interests to dictate policy in this area.

The experience of Indian surrogate mothers is heart rending. Procured mostly from slums through agents, these women are removed from their homes and incarcerated in hostels until the surrogate child is born. Unempowered and desperate, the women undertake the risk of the additional pregnancy, clinical procedures and delivery for the monetary benefit they will bring. 

To increase the chance of success, surrogates are implanted with multiple embryos and often have to carry twins, undergo foetal reduction procedures and agree to Caesarian section for the safety of the child. The HBO documentary ‘Outsourcing Embryos’ by journalist Gianna Toboni is just one of many painful exposes on the darker side of surrogacy in India.

Children born through surrogacy are also vulnerable. If the commissioning parents change their mind and refuse the child, it is left for adoption at a state orphanage. When foreigners are involved, dissimilar country laws regarding adoption and citizenship create complications that can be unfair and detrimental to the child.

The tragic story of Baby Manji, a surrogate child born in India is still fresh in the collective mind. Abandoned in India by a Japanese couple who got divorced just before her birth, she was later claimed, with special permission, by her Japanese grandmother on the guarantee that the child would be assured Japanese citizenship.

In another shocking case in 2012, an Australian couple accepted only one of a pair of twins born through a surrogate arrangement in Delhi. They arranged to have the other child adopted by a couple in India. After this turned created international furore, Australian authorities agreed to confer citizenship on the abandoned twin if the adoption was illegal. This raises the spectre of child trafficking and commoditisation of children in the absence of adequate oversight.

In response, the ART Bill 2015 proposes that commercial surrogacy be allowed only for foreigners married to Indian citizens, overseas citizens of India (OCI), people of Indian origin (PIO) and non-resident Indians (NRI). This amendment does not fully address the issue of conflicting country laws relating to citizenship and adoption and exploitation of women.

This very year, two other Asian countries have toughened legislation in this area. Thailand has banned commercial surrogacy for foreigners and same-sex couples following a scandal involving ‘Baby Gammy’, a surrogate twin abandoned in Thailand as he had Downs syndrome, while his healthy twin sister was taken abroad.

Nepal, too, has banned all surrogacy arrangements in response to the public outcry over selective airlifting of surrogate babies in the wake of recent earthquake. The rescue was privately organised by affluent commissioning couples, unmindful of the surrogate mothers left behind. The irony of this story is that the surrogate mothers were mostly of Indian nationality, as Nepal does not allow its own citizens to enter into commercial surrogacy arrangements.

Multi-million dollar business
Surrogacy in India is now a multi-million dollar business offering the attraction of lower costs, permissive laws and availability of surrogate women. There are many who are profiteering from promoting surrogacy, for medical indications that warrant surrogacy are extremely limited. This blatant exploitation of vulnerable women in the name of medical treatment is unacceptable.

When poverty drives women to risk their mental and physical health, even using their bodies for financial return in this manner, dignity of the human being and respect for motherhood is undermined. Just as commercial organ donation was prohibited in India by the Transplantation of Human Organs Act 1994, commercial surrogacy must not be allowed, as these contracts are unconscionable, unenforceable and unethical.

Is it possible to put a price on the human body or an organ? For this reason, organ donation, blood donation and even human cadaver donation are altruistic. As in the case of organ donation, altruistic surrogacy arrangements could be allowed, with adequate regulation and oversight.

There is still a long way to go in providing protection, safety and well-being to every woman and girl child in India. Let this not be one more avenue of possible exploitation, whether by foreigners or Indians. We have the responsibility to ensure that the proposed Assisted Reproductive Technology Bill 2015 is reviewed.

The legislation must reflect this country’s commitment to human rights and children’s rights as signatories to the international charter of rights. In a country that is striving to ensure that women are included, educated, empowered and have a voice in the democratic and social arena, commercial surrogacy has no place at all.