Surrogacy

Surrogacy is an arrangement in which a woman carries and delivers a child for another couple or a person. This woman, the surrogate mother, may be the child's genetic mother (called traditional surrogacy), or she may be genetically unrelated to the child (called gestational surrogacy). If the surrogate receives compensation beyond the reimbursement of medical and other reasonable expenses, the arrangement is called commercial surrogacy; otherwise, it is often referred to as altruistic surrogacy.[1] In a traditional surrogacy, the child may be conceived via home artificial insemination using fresh or frozen sperm or impregnated via IUI (intrauterine insemination), or ICI (intracervical insemination) performed at a health clinic. A gestational surrogacy requires the transfer of a previously created embryo, and for this reason the process always takes place in a clinical setting.

Is surrogacy for whom?

Surrogacy may be appropriate if you have a medical condition that makes it impossible or dangerous to get pregnant and to give birth.

The type of medical conditions that might make surrogacy necessary for you include:

•             Absence or malformation of the womb

•             Recurrent pregnancy loss

•             Repeated in vitro fertilisation (IVF) implantation failures.

•             Cancerous Infection in Uterus

•             Higher use contraceptives measures such as pills, copper T etc.

How does surrogacy work?

Full surrogacy (also known as Host or Gestational) - Full surrogacy involves the implantation of an embryo created using either:

•             The eggs and sperm of the intended parents

•             A donated egg fertilized with sperm from the intended father

•             An embryo created using donor eggs and sperm.

Partial surrogacy (also known Straight or Traditional) - Partial surrogacy involves sperm from the intended father and an egg from the surrogate. Here fertilisation is (usually) done by artificial insemination or intrauterine insemination (IUI).

Success rate:

It is quite difficult to determine a success rate for surrogacy, as many factors are relevant, including:

•             The surrogate’s ability to get pregnant

•             The age of the egg donor (if involved)

•             The success of procedures such as IUI and IVF

•             The quality of gamete provided by the commissioning couple.

The age of the woman who provides the egg is the most important factor that affects chances of pregnancy. The potentiality of the donated egg is to be checked under strong medical observations and should be potent to get fertilized.

 Risks of surrogacy:

The risks associated with surrogacy depend on the type of surrogacy (full or partial) undertaken. Generally, the risks associated with full surrogacy are similar to those for IVF.

Risks of fertility treatment:

There is also a risk of transferring HIV and hepatitis, and so screening of everyone involved in surrogacy involving IUI is recommended, and required in surrogacy arrangements involving IVF.  If a registered donor at a licensed clinic is used, the donor will automatically be screened.

Surrogacy in India:

Surrogacy in India continues to be a very sensitive topic. The laws meant to regulate surrogacy are still in nascent stages, as they are stuck at various legislative levels. The only guidelines currently related to this field are those of the Indian Medical Association (IMA), which date back to 2006. Meanwhile, surrogacy is growing rapidly by the day, thanks to India emerging as a centre for medical tourism and being one of the few countries in the world where commercial surrogacy is widely available. Estimates for the value of this industry is of about Rs.20 billion.

The legal situation in India is in sharp contrast to that existing in many other countries. In Germany and Canada, surrogacy is outlawed or prohibited. In U.K it is highly regulated and very expensive. In Germany, over the last three years, there have been two controversial cases. The first, in 2008, involved twins born to a surrogate mother; the second arose barely a year ago. In both cases, German authorities refused to automatically give passports to children born of surrogate procedures carried out in India. The main reason for the refusal of visas was because surrogacy is not allowed in Germany. This is a homogenous and consistent line of reasoning and is very much in contradiction to the state of affairs in India where at the moment this sector is almost completely unregulated.

There are references in Indian mythology to surrogacy, most notably in the legend surrounding Lord Krishna. But it is not commercial surrogacy. Today, the small Gujarat town of Anand, well known for its milk products, has rapidly put itself on the global map as the most fertile ground for ‘surrogacy tourism’. All evidence suggests that the phenomenon has now spread from cities to smaller towns in India, with many of the centres calling themselves in vitro fertilisation (IVF) clinics to avoid public scrutiny.

Of course, there is not much emphasis given to the setting up of norms to govern this growing industry. The IMA guidelines are more like normative principles that are required to be followed and not statutory instruments that invite penalties.

At present, in India the understanding between the surrogate mother and the commissioning parents is considered a contract, with a mention made of compensation to be paid to the mother. So although the guidelines recognize the existence of commercial surrogacy, it is relegated to the realm of an ordinary business contract. In other words, jurisprudence developed for commerce along with medical guidelines are the only form of regulation of a business that is referred to as and one can only assume without irony  as ‘wombs for rent’.

The Law Commission of India has brought out a report on surrogacy and the urgent need for regulation entitled, ‘Need for Legislation to Regulate Assisted Reproductive Technology Clinics as well as Rights and Obligations of Parties to a Surrogacy’. Unfortunately, this report, too, is now over three years old and the draft legislation on the issue — The Assisted Reproductive Technologies (Regulation) Bill, 2010 (ART) is still nowhere in sight as a legally enforceable statute. 

The draft Bill itself is not without contentious issues since it is drafted from the perspective of the commissioning parents. The methods of payment to the surrogate and the other arrangements it lays down seem to suggest that the surrogate figures low in the list of priorities in terms of care and protection. This is disturbing considering that surrogacy raises several ethical considerations including the fact that it leaves poor women at the mercy of a capricious system.

These women often have no other recourse other than commercial surrogacy arrangements to buy themselves and their families out of debilitating circumstances. SAMA (Resource Group for Women and Health) headquartered at Delhi, is a resource group working in the area of women and health, has raised concerns regarding the current situation as well as serious problems with the Bill. The number of pregnancies, the types of procedures and the care of the surrogate are all matters that have been inadequately addressed, both by the medical system as it exists today and the Bill.

There is also the issue of race and ethics to be considered. In addition, it is pertinent to note that there is hardly the required encouragement to look at adoption as a viable alternative to surrogacy to parents willing to consider this as an option to add to their family.

The Supreme Court, in the 2008 case of Baby Manji Yamada v/s Union of India discussed surrogacy and noted that commercial surrogacy is reaching industrial proportions because of the ready availability of poor surrogates. It mentioned the Commissions for Protection of Child Rights Act, 2005 but stopped short of demanding that the government take immediate action to regulate the whole surrogacy industry, and not just address the issue of the rights of the child once it is born.

But while civil society groups, the media, the courts and the Law Commission have periodically focused on the various negative aspects of the surrogacy industry, the apathy of the country’s own legislators makes one wonder what is required to spur them to address the serious ethical and moral dimensions of this unregulated enterprise.