A New Twist On "Made in India"

By Amelia Gentleman, of the New York Times news service, Mumbai, India

Outsourcing is taking a new direction as India's skilled doctors and liberal laws combine to create a new kind of baby boom

Gher and his partner, who are Israeli, plan eventually to tell their child about being made in India, in the womb of a stranger, with the egg of a Mumbai housewife they picked from an Internet lineup.

The embryo was formed in January in an Indian fertility clinic about 4,000km from the couple's home in Tel Aviv, produced by doctors who have begun specializing in surrogacy services for couples from around the world.

"The child will know early on that he or she is unique, that it came into the world in a very special way," said Gher, 29, a communications officer for the environmental group Greenpeace.

An enterprise known as reproductive outsourcing is a new but rapidly expanding business in India. Clinics that provide surrogate mothers for foreigners say they have recently been inundated with requests from the US and Europe, as word spreads of India's mix of skilled medical professionals, relatively liberal laws and low prices.

Commercial surrogacy, which is banned in some states and some European countries, was legalized in India in 2002. The cost comes to about US$25,000, roughly a third of the typical price in the US. That includes the medical procedures; payment to the surrogate mother, which is often, but not always, done through the clinic; plus air tickets and hotels for two trips to India (one for the fertilization and a second to collect the baby).

"People are increasingly exposed to the idea of surrogacy in India; Oprah Winfrey talked about it on her show," said Kaushal Kadam at the Rotunda clinic in Mumbai.

Just an hour earlier she had created an embryo for Gher and his partner with sperm from one of them (they would not say which) and an egg removed from a donor just minutes before in another part of the clinic.

The clinic, known more formally as Rotunda -- The Center for Human Reproduction, does not permit contact between egg donor, surrogate mother or future parents. The donor and surrogate are always different women; doctors say surrogates are less likely to bond with the babies if there is no genetic connection.

There are no firm statistics on how many surrogacies are being arranged in India for foreigners, but anecdotal evidence suggests a sharp increase.

Rudy Rupak, co-founder and president of PlanetHospital, a medical tourism agency with headquarters in California, said he expected to send at least 100 couples to India this year for surrogacy, up from 25 last year, the first year he offered the service.

"Every time there is a success story, hundreds of inquiries follow," he said.

FREE OF VICE

In Anand, a city in the eastern state of Gujarat where the practice was pioneered in India, more than 50 surrogate mothers are pregnant with the children of couples from the US, Britain and elsewhere. Fifteen of them live together in a hostel attached to the clinic there.

Naina Patel, who runs the Anand clinic, said that even Americans who could afford to hire surrogates at home were coming to her for women "free of vices like alcohol, smoking and drugs." She said she gets about 10 e-mailed inquiries a day from couples abroad.

Under guidelines issued by the Indian Council of Medical Research, surrogate mothers sign away their rights to any children. A surrogate's name is not even on the birth certificate.

This eases the process of taking the baby out of the country. But for many, like Lisa Switzer, 40, a medical technician from San Antonio, Texas, whose twins are being carried by a surrogate mother from the Rotunda clinic, the overwhelming attraction is the price.

"Doctors, lawyers, accountants, they can afford it, but the rest of us -- the teachers, the nurses, the secretaries -- we can't. Unless we go to India," she said.

Surrogacy is an area fraught with ethical and legal uncertainties. Critics argue that the ease with which relatively rich foreigners are able to "rent" the wombs of poor Indians creates the potential for exploitation. Although the government is actively promoting India as a medical tourism destination, what some see as an exchange of money for babies has made many here uncomfortable.

India's Ministry of Women and Child Development said last month that it was weighing recommending legislation to govern surrogacy, but it is not imminent.

An article published in the Times of India in last month questioned how such a law would be enforced.

"In a country crippled by abject poverty, how will the government body guarantee that women will not agree to surrogacy just to be able to eat two square meals a day?" the paper asked.

Even some of those involved in the business of organizing surrogates want greater regulation.

"There must be protection for the surrogates," Rupak said. "Inevitably, people are going to smell the money and unscrupulous operators will get into the game. I don't trust the industry to police itself."

He said that the few doctors offering the service now were ethical and took good care of the surrogates but that he was concerned this might change as the business expanded.

Gher and his partner, who asked not to be named to preserve his privacy, have worked through their doubts and are certain they are doing a good thing.

"People can believe me when I say that if I could bear the baby myself I would," Gher said. "But this is a mutually beneficial answer. The surrogate gets a fair amount of money for being part of the process."

The couple is paying about US$30,000, of which the surrogate gets about US$7,500.

"Surrogates do it to give their children a better education, to buy a home, to start up a small business, a shop," Kadam said. "This is as much money as they could earn in maybe three years. I really don't think that this is exploiting the women. I feel it is two people who are helping out each other."

Gher agreed.

"You cannot ignore the discrepancies between Indian poverty and Western wealth," he said. "We try our best not to abuse this power. Part of our choice to come here was the idea that there was an opportunity to help someone in India."

THUMBPRINT

In the Mumbai clinic, it is clear that an exchange between rich and poor is under way. On some contracts, the thumbprint of an illiterate surrogate stands out against the clients' signatures.

Although some Indian clinics allow surrogates and clients to meet, Gher said he preferred anonymity. When his surrogate gives birth later this year, he and his partner will be in the hospital, but not in the ward where she is in labor, and will be handed the baby by a nurse.

The surrogate mother does not know that she is working for foreigners, Kadam said, and has not been told that the future parents are both men. Gay sex is illegal in India.

Israel legalized adoption by same-sex couples last month, but such couples are not permitted to hire surrogates in Israel to become parents. A fertility doctor recommended Rotunda, which made news in November when its doctors delivered twins for another gay Israeli couple.

Rotunda did not allow interviews with its surrogate mothers, but a 32-year-old woman at a fertility clinic in New Delhi explained why she is planning on her second surrogacy in two years.

Separated from her husband, she found that her monthly wages of 2,800 rupees, about US$69, as a midwife were not enough to raise her nine-year-old son. With the money she earned from the first surrogacy, more than US$13,600, she bought a house. She expects to pay for her son's education with what she earns for the second, about US$8,600. (Fees are typically fixed by the doctor and can vary.)

"I will save the money for my child's future," she said.

The process requires some subterfuge in this socially conservative country. The woman has told her mother, who lives with her, but not her son or their neighbors. She has told the few who have asked her outright that she is bearing a child for a relative.

So far, for the Israeli couple, the experience of having a baby has been strangely virtual. They perused profiles of egg donors that were sent by e-mail ("We picked the one with the highest level of education," Gher said).

From information that followed, they rejected a factory worker in favor of a housewife, who they thought would have a less stressful lifestyle.

Gher posts updates about the process on Facebook. And soon the clinic will start sending ultrasound images of their developing child by e-mail. Highly pixilated, blown-up passport photos of the egg donor and surrogate mother adorn a wall of their apartment in Israel.

"We've been trying to half close our eyes and look at it in a more holistic way to imagine what she would actually look like," Gher said of the donor's blurred image. "These are women we don't know, will never know, who will become in a way part of our lives."