Wombs for Rent, Cheap

ANAND, India —  As temp jobs go, Saroj Mehli has landed what she feels is a pretty sweet deal. It’s a nine-month gig, no special skills needed, and the only real labor comes at the end -- when she gives birth.

If everything goes according to plan, Mehli, 32, will deliver a healthy baby early next year. But rather than join her other three children, the newborn will be handed over to an American couple who are unable to bear a child on their own and are hiring Mehli to do it for them.

She’ll be paid about $5,000 for acting as a surrogate mother, a bonanza that would take her more than six years to earn on her salary as a schoolteacher in a village near here.

“I might renovate or add to the house, or spend it on my kids’ education or my daughter’s wedding,” Mehli said.

Beyond the money, she said, there is the reward of bringing happiness to a childless couple in the United States, where such a service would cost them thousands of dollars more, not to mention the potential legal hassles.

Driven by many of the same factors that have led Western businesses to outsource some of their operations to India in recent years, an increasing number of infertile couples from abroad are coming here in search of women such as Mehli who are willing, in effect, to rent out their wombs.

The trend is evident to doctors such as Indira Hinduja, perhaps India’s most prominent fertility specialist, who receives an inquiry from overseas every other week. It can also be detected on the Internet, where a young Indian woman recently posted an ad on a help-wanted website offering to carry a child for an expatriate Indian couple.

Then there is the dramatic example of Mehli’s family. Two of her sisters have already served as surrogates -- one of them for foreigners -- and so has a sister-in-law. Mehli finally decided to join in, with the enthusiastic consent of her husband, a barber, and the guidance of a local doctor who has become a minor celebrity by arranging more than a dozen surrogacies in the last two years, for both Indian and non-Indian couples.

Some see the practice as a logical outgrowth of India’s fast-paced economic growth and liberalization of the last 15 years, a perfect meeting of supply and demand in a globalized marketplace.

“It’s win-win,” said S.K. Nanda, a former health secretary here in Gujarat state. “It’s a completely capitalistic enterprise. There is nothing unethical about it. If you launched it somewhere like West Bengal or Assam” -- both poverty-stricken states -- “you’d have a lot of takers.”

Others aren’t so sure about the moral implications, and are worried about the exploitation of poor women and the risks in a land where 100,000 women die every year as a result of pregnancy and childbirth. Rich couples from the West paying Indian women for the use of their bodies, they say, is distasteful at best, unconscionable at worst.

“You’re subjecting the life of that woman who will be a surrogate to some amount of risk,” said C.P. Puri, director of the National Institute for Research in Reproductive Health in Mumbai (formerly Bombay). “That is where I personally feel it should not become a trade.”

Both sides of the debate agree that the fertility business in India, including “reproductive tourism” by foreigners, is potentially enormous. Current figures are tough to pin down, but the Indian Council of Medical Research estimates that helping residents and visitors beget children could bloom into a nearly $6-billion-a-year industry.

“It’s definitely going to increase with education and literacy, especially in a country like India,” said Gautam Allahbadia, a fertility specialist in Mumbai who recently helped a Singaporean couple find an Indian surrogate. He has received similar inquiries from the United States, Israel and Spain.

A Mini Baby Boom

In the vanguard of the nascent industry is this small city, where gynecologist Nayna H. Patel is presiding over a mini baby boom. But eight of her recent and imminent arrivals won’t be adding to Anand’s population of 100,000: Three of the infants are destined for the U.S., two for Britain and three for other parts of India. (Six more surrogacy attempts were unsuccessful.)

Before Patel’s practice began attracting national and international notice, Anand was famous for decades as the milk capital of India, home to the country’s most successful dairy farmer cooperative.

Now the town also boasts about 20 young women who have volunteered to be implanted with embryos at Patel’s clinic. A few have already gone through the process once and are eager for a second go-round.

Prospective foreign clients hear of Patel through word of mouth or informal online networks and websites dealing with infertility issues. By the time they contact her, and spend the time, energy and money to get here, they are usually desperate for children and often emotionally battered after years of trying and failing to conceive.

Patel has set some criteria for those she’ll help: only childless couples in which the wife is either infertile or physically unable to carry a fetus to term.

Likewise, potential surrogates must be between 18 and 45, in good health, and mothers in their own right, for physical and psychological reasons -- physical, so they know what awaits their bodies, and psychological, so they feel less troubled about giving up the baby because they already have children. The egg that contributes to the embryo is never one of their own, coming instead from an anonymous donor or the intended mother, and then usually fertilized in vitro.

Both parties sign a contract under which the intended parents pay for medical care and the surrogate renounces rights to the baby, a provision that relieves the fears of many foreign couples. In the U.S., for example, where laws vary from state to state, the surrogate sometimes has a window of opportunity after the birth to stake a claim on the child, which can precipitate nightmarish custody battles.

In Anand, volunteers are repeatedly reminded by Patel and her staff that the fetuses in their wombs are not theirs. They give up the newborns within one to two days after delivering. No problems have arisen yet with too strong a bond forming between surrogate and child, Patel said.

“Their first question is, ‘Is the baby OK?’ The second is, ‘Is the couple happy?’ And then they say, ‘Thank God,’ ” Patel said. “And then they don’t think about it after that.”

She acknowledged that money was the primary reason these women had queued up to be surrogates; without it, the list would be short, if not nonexistent. Payment usually ranges from about $2,800 to $5,600, a fortune in a country where annual per capita income hovers around $500.

But Patel cited cultural components as well -- an empathy with the childless here in a society that views producing progeny as an almost sacred obligation, and Hindu teachings about being rewarded in the next life for good deeds performed in this one.

“Those couples who don’t have kids long for them, and I can understand their feelings,” said Smita Pandy, 27, who has two children of her own and was about to give birth on behalf of another Indian couple. “I’ll be happy because they’ll be blessed with a child.”

Her husband, Jagruth, looks at it this way: Just as he and his family live in a rented house, his wife’s womb is also providing temporary shelter -- for a fee -- to a child belonging to someone else.

Despite his liberal outlook, traditional attitudes on sex and procreation, which make surrogacy seem incomprehensible and taboo to many, still prevail in the Indian countryside. Mehli, the woman who has agreed to act as a surrogate for an American couple, has invented a cover story for her neighbors.

“I’ll say that I’m pregnant with my husband’s child, and once I have to part with the baby, I’ll say that it died,” she said.

She doesn’t worry about potential ill effects of the pregnancy on her own physical or mental health. But it’s a question that concerns Puri, the director of the reproductive health research institute in Mumbai.

“If we look at who is likely to become a surrogate for monetary gain, it’s people who are from low socioeconomic status,” Puri said. “If we look at the mortality and morbidity associated with pregnancy and childbirth, it’s a lot more in this class of people.”

India has no laws regulating the fertility industry, only nonbinding guidelines issued by the national medical research council. The group has urged the government to enact legislation to ensure protection of rights on all sides.

Doctors who have assisted infertile couples from abroad in hiring surrogates insist that they guard against exploitation and provide high-quality care. They bristle at comparisons of surrogate mothers to people who sell their organs, an act they describe as perverse and completely different from harnessing the natural maternal cycle.

“You’re not losing any organ,” Patel said. “This is physiological, pregnancy and delivery. When you remove a kidney, it becomes pathological.”

Showered With Gifts

In addition, many of the surrogate mothers are showered with gifts of food and medicine and monitored with solicitous attention by the waiting parents, usually educated, sophisticated people who want to ensure that their investment yields its much-hoped-for fruit.

The American who has hired Mehli said he and his wife had discussed all options for having a child in light of her hysterectomy 10 years ago. Surrogacy was one possibility, but at a minimum of $20,000 to $25,000 in the U.S., “the expenses involved were almost beyond my reach,” said the man, who asked that he be identified only by his last name, Singh, because of the delicate subject.

His doctor suggested that Singh and his wife look to India for a solution. Because Singh is of Indian descent -- like many of the foreigners who seek surrogates here -- the idea appealed to him.

He recently journeyed to Anand on a hot afternoon to meet Mehli, sign the contract and donate sperm, which will be matched with an egg from an anonymous donor.

“It makes me comfortable to see that she has kids, and her husband is here today and I can talk to him,” said Singh, who lives in the western U.S. “It gives me more confidence that I or someone from my family can visit even during pregnancy.”

The cost of the in-vitro fertilization and surrogacy process is expected to total about $7,200. Even with travel expenses factored in, the overall cost will work out to much less than in the U.S., he said as he sat in Patel’s office.

In the lobby, a dozen barefoot women in vividly colored saris waited patiently to see the doctor. Over their heads, tacked up along one wall, were thank-you notes from proud parents and photos of their smiling or sleeping babies.

By this time next year, Singh hopes to be represented on that wall.